n 






OBSERVATIONS 



UPON THE 



AUTUMNAL FEVERS 



OF 



SAVANNAH. 



✓ 

BY W. C. DANIELL, M.D. 



i: Le premier devoir du mddecin, est d'agir sur le principe de r&action" 

Berlinghieri. 




PUBLISHED BY W. T. WILLIAMS ; AND BY COLLINS & HANNAY, 
NEW- YORK. 



1826. 




DISTRICT OF GEORGIA. 

BE IT REMEMBERED, That on the twenty-second day oi October, 
one thousand eight hundred and twenty-five, and m the fiftieth year of 
the Independence of the United States of America, William C. Daniell ot 
Savannah, in said District, hath deposited in this office the title of a Book, 
the right whereof he claims as author in the words following, to wit : — 

" Observations upon the Autumnal Fevers of Savannah. By William C. 
Darnell, M. D. 

' Le premier devoir du medecin, est d'agir sur le principe de reaction.' 

Berlinghieri." 

In conformity to the Act of the Congress of the United States, entitled 
c ' An Act for the encouragement of Learning, by securing the copies of 
Maps, Charts, and Books, to the authors and proprietors of such copies, 
during the times therein mentioned." And also to the Act, entitled " An 
Act, supplementary to an Act, entitled An Act for the encouragement of 
Learning, by securing the copies of Maps, Charts, and Books, to the authors 
and proprietors of such copies, during the times therein mentioned, and 
extending the benefits thereof to the arts of designing, engraving, and etching 
historical and other Prints." GEO. GLEN, 

Clerk District of Georgia 




.V 



TO N. CHAPMAN, M.D. 

'HQFESSOR OF THE INSTITUTES AND PRACTICE OF PHYSIC AND 
CLINICAL PRACTICE, IN THE UNIVERSITY OF 
PENNSYLVANIA, 



The following sheets are respectfully inscribed, as a 
feeble acknowledgment of many acts of kindness, and 
repeated evidences of friendship to the author, as well 
as a fleeting testimony of the high estimation in which 
his talents and attainments, both professional and literary, 
are held in common with the world, by 

THE AUTHOR-. 

Savannah, 

Uth October, 1825, 



INTRODUCTION. 



In submitting the following brief remarks, 
upon the character and treatment of the au- 
tumnal fevers of Savannah, to the public, I feel 
much embarrassment. I well know the scepti- 
cism with which innovations of any kind are 
received by the world ; and I should offer the 
gleanings of my own observations with less dif- 
fidence, if they possessed less novelty. Although 
it be my fortune to entertain opinions which have 
the sanction of neither time nor authority, I 
cannot, with any justice, be reproached for con- 
victions, which experience, as diligent and dis- 
passionate as I could make it, has forced upon 
me. It is true, I may overrate the importance 
of such opinions ; if I do, it cannot be doubted 
that both reproof and rebuke await me. Of 
my opinions and practice, I have neither sought 
concealment, nor made mystery ; of both I have 
invited examination. 

If there be a situation more trying than that 
of a physician, who, from a sense of duty, has 



vi 



INTKODUCTIOX. 



watches its course for new lights to guide him in 
search of more efficient remedies, and supposing 
he has manifestations of them, pursues them 
cautiously and considerately amid the prejudices 
of a community, and the calumny of his profes- 
sional brethren, I know not where it is to be 
found in the temporal affairs of men. Such, for 
the greater part of the last eight years, has been 
my situation. The force of public opinion has 
eventually driven my opponents from their old 
coverts, and little is now heard of inflammations 
of the stomach and bowels, caused by our fevers; 
and much less of bleedings, and blisters, drastic 
purgatives and salivations in their treatment. 

It was m} misfortune, in the commencement 
of my professional career, to engross a larger 
practice than my experience authorized. Ar- 
dent in my own feelings, I had, in adopting the 
opinions of standard authors, attributed too great 
an importance to the weight of their experience; 
disappointment was the consequence. How- 
ever, too buoyant in my feelings to despond, I 
devoted myself to a re-examination of the re- 
cords of my profession, and rendered cautious 
by the short experience which I had derived 
from my practice, I was enabled to detect, as I 
supposed, frequent misgivings which had before 
escaped me. I was frequently, moreover, re- 
abandoned an established mode of treating an 
epidemic, and who attentively and diligently 



INTRODUCTION". Vll 

•minded of a remark of my kind preceptor, Pro- 
fessor Chapman, that he who would devote 
himself to selecting the true from the false ex- 
perience of medical writings, would confer a 
lasting obligation upon the profession. The 
greatest advantage which I derived from the 
study connected with my own observations, was 5 
a settled conviction, that the character and treat- 
ment of our autumnal fevers were yet to be learn- 
ed. I resolved to await a favourable opportunity 
of studying them, divested of any bias as to their 
character. This was amply afforded in the season 
of 1817, early in which the fever appeared, and 
prevailed extensively till winter. I soon found 
myself involved in a practice which gave me 
but little time for minute and attentive examina- 
tion or much deliberation. I was hurried on 
from day to day, and from case to case, more 
elated with the extent of my practice, than hum- 
bled by the high responsibility of my trust, or 
the embarra^/nent of toy situation. It is true, 
I endeavoured to atone for what I considered 
the defective character of the treatment, by 
pursuing it with greater energy: my success 
was deemed equal to that of others ; and I en- 
deavoured to conceal from myself, my dissatis- 
faction at the mode of treatment which, in com- 
mon with other physicians, I pursued. 

The time soon arrived, however, which dis- 
pelled the delusion. About the latter end of 




via 



INTRODUCTION. 



August, and during September, there was a 
very considerable abatement of disease. This 
arose from an absence of subjects; for, to- 
wards the close of the latter month, several 
vessels irrived from Europe and the north. 
The seamen and passengers which they afford- 
ed, very soon became sickly ; and with them, 
the fever assumed a much more severe and rapid 
character. Their numbers were increased from 
day to day, by new arrivals. Here the disease 
ran its course in two to five and six days. Eva- 
cuants, even the mildest, could not be borne. 
There was, from the first, great debility. Blis- 
ters frequently failed to vesicate. Indeed, 
nothing appeared even for an hour, to arrest 
the disease. It soon became obvious that every 
attempt to salivate must be nugatory. It was 
at this time, that I became first impressed with 
the importance of the loss of tone in the 
skin ; and of the necessity of the adoption of 
some means to restore it. There was not time 
for much deliberation. I endeavoured to make 
blisters available, by increasing the proportion 
of the flies, and by the addition of Spt. Tere- 
binth., but with no advantage. The season pro- 
gressed : disease and death thickened around 
us. The fevers manifested a direct and speedy 
tendency to prostration. To me, it became 
evident, that such speedy and constant collapse, 
was the eflfect of a debilitating cause ; that the 



INTRODUCTION. IX 



fever originating in debility, was perpetuated by 
it, and the system sunk under its direct in- 
fluence. I could not conceive that any inflam- 
matory disease, without obvious and palpable 
manifestations of a high excitement (none of 
which existed) could so speedily end in prostra- 
tion. I sought counsel from some of the medi- 
car gentlemen of the place: with more expe- 
rience, (and, perhaps, more discretion, certainly 
with more caution,) they professed to see no 
reason why we should doubt the efficacy of a 
system of treatment which was supported by 
the opinions of so many great men, and which 
had the authority and sanction of time. It was 
true, (said they) that the disease is of a high 
grade, and many ca^es terminate fatally. That 
they continued, is to be attributed rather to the 
severity of the fever, than the want of virtue in 
the remedies. To my mind, all this was by no 
means satisfactory. Those who had confided 
in me, were daily dying around me. They 
looked to me for a succour which I had not been 
enabled to afford them. I was humbled to the 
dust ; for I felt my attendance amounted almost 
to imposture. If I had believed the disease to 
be absolutely incurable, my feelings would have 
been different. In a state of feeling, to which 
even at this day, I cannot recur without pain, 
in several cases then under treatment, I re- 
solved to abandon a practice which, at least, 
B 



INTRODUCTION. 



in my hands, had achieved nothing, and I substi- 
tuted an infusion of serpentaria with bark. This 
prescription was sent out in the evening. Though 
wearied and exhausted with the fatigues of the 
day, I felt that I could not sleep. I traversed my 
parlour in a state of mental anxiety, which I 
never felt before, nor since, for several hours 
after midnight. I then sought my chamber ; my 
dreams carried me to the bedside of my patients, 
whom I imagined were dying. I awoke, but to 
repeat my horrible visions. Eventually, the 
hour arrived, when I could visit m) patients. 
Their condition soothed my anxiety : for no evil 
had yet resulted from my tonic remedies. They 
were persisted in afterwards with decided 
advantage In new cases, I resorted to them 
earlier, and my success with them, although not 
satisfactory, was infinitely greater than with the 
other remedies which I had previously used. 
Urgent business called me to the interior of the 
state, about the first of November. 

In the following winter, I detailed the result 
of my success with the bark and serpentaria to 
some medical friends, especially to the late Dr. 
Kollock ; who had been absent the preceding 
season, and whose confidence and friendship it 
was my good fortune always to enjoy. The dis- 
trust with which all received my relation, gave 
me much pain ; and eventually (though it may 
appear a weakness to acknowledge it) impaired 



JNTRODUUTIOS* M 

my own confidence in the treatment which I had 
adopted. 

To the influence of the dry culture system, 
which went into operation the following year, 
(and which from the fine condition in which the 
lands were from their cultivation in rice the pre- 
ceding,) we owe the comparative exemption 
from fever enjoyed in 1818. Owing to this cir- 
cumstance, and my ill health in 1819, 1 had very 
few opportunities of seeing cases of fever until 
the appearance of the fatal epidemic of 1820. 
My conversations with physicians, both at home 
and abroad, during this interval, showed me, 
that in doubting the efficacy of the depleting and 
mercurial system of treating autumnal fevers, 
I stood almost alone. The only physician, whom 
I conversed freely with, who seemed to think I 
might be correct, was the late Dr. Berrien ; 
who, in falling a victim to the fever of 1820, de- 
prived his state of one of her most valuable citi- 
zens, and his profession of one of its brightest 
ornaments. Such language applied to a man of 
twenty-five years, may be deemed complimentary; 
but, I appeal with confidence, to those who knew, 
and could appreciate him, for its justice. In the 
death of Dr. Berrien, I lost both a sincere friend 
and a fellow-labourer, in investigating the nature 
and treatment of our fevers. He had already 
united with me in the use of sinapisms and 
Cayenne pepper ; of whose utility, he expressed 



INTRODUCTION. 



himself confidently, from the short experience 
which was afforded him in 1820, previously to 
his illness and subsequent death. 

In the early cases of fever, that fell under my 
care during that season, I pursued the establish- 
ed mode of treatment ; from which, however, I 
was soon driven by my want of success. Bark 
and serpentaria I then prescribed cautiously. 
They were frequently either rejected, or the 
head became affected, and they were disconti- 
nued. — Cayenne pepper (in infusion) was then 
tried by me, and with some success. In one 
case, (that of a Mrs. Nickerson,) it suppressed 
the black vomit; and she recovered. Although, 
encouraged to continue this article, it was evident 
that something in addition was necessary. It 
was soon pretty fully understood that this fever 
resisted all the usual modes of treatment. Pub- 
lic confidence became much impaired in even 
our most experienced physicians. Many popu- 
lar medicines were suggested and used without 
consulting a physician ; among these, snakeroot 
and salts administered in divided doses, received 
much attention. Some used the serpentaria, 
others the Seneka snakeroot. I saw several, in 
whom this combination produced excessive 
retchings. In such cases, I derived great advan- 
tage from the use of pepper tea. I aided that, 
in many cases of fever, by the use of sinapisms. 
These were certainly serviceable. At first. T 



INTRODUCTION. 



xiii 



relied upon merely their rubefacient effect ; af- 
terward, I kept them on until the skin was in- 
flamed. My success, though by no means great, 
yet attracted at the time considerable attention. 
It was inquired from a neighbouring cit} , what 
were the remedies I had used, and their mode of 
administration. 

At this (to me, an interesting) period, I be- 
came myself ill with fever, from which I did not 
recover, until the termination of the season. 
During my illness, it was frequently a most 
painful reflection to me, that I had been sudden- 
ly arrested in the midst of investigations which 
appeared to me fraught with the deepest interest 
to my fellow -citizens. Since, I have pursued 
regularly and constantly these inquiries. They 
have led me to the introduction of a new system 
of treatment, in our autumnal fevers, and to a 
new theory of their nature atid character. My 
opinions of our fevers have been the offspring of 
the success of the medicines which 1 have used, 
and of examinations of the dead. My explana- 
tion of the action of our fevers may be errone- 
ous. I cannot have been deceived either in the 
success of my treatment, or in the post mortem 
appearances which are detailed in the following 
pages. 

That I feel a solicitude for the fate that awaits 
these Observations, it would be folly to deny. 
Tn this anxiety, however, there is but little that 



xiv 



INTRODUCTION. 



is selfish. — Limited in my professional views, to 
a small town, where personal address is of more 
importance, than higher qualifications, I feel that 
I shall be but little affected by the judgment 
which the medical public may pass upon my la- 
bours. I also know, that whilst I may be sum- 
marily and hastily condemned, what I may gain, 
will be silently and slowly acquired. The revo- 
lution, which I propose in the long established 
opinions, of a whole profession, if ever achieved, 
must be the work of time. — In medicine, as in 
religion, there is no standard by which matters 
of opinion, can be measured in the sight of men ; 
and in the one, as in the other, much depends 
upon the faith of the parties. Hence, the bit- 
terness of the controversies concerning either, 
I expect few converts among those who have 
long pursued the profession. It is to those, who 
are to be the future physicians of the southern 
states, where the fevers of which I treat are 
habitual and destructive, that I would most 
earnestly appeal. To this hour, the judgments 
of the southern physicians, are chained to the 
desks of the northern schools. The latter com- 
plain of the undue influence which European 
doctrines exercise over the minds of the Ameri- 
can physicians. That is not more preposterous, 
than the professional sovereignty of the north 
is, over the south. 

No man feels a higher respect for the talents. 



INTRODUCTION. 



XV 



learning, and industry of the medical gentlemen 
of the northern and middle states : — no one is 
more gratified than myself, at the honourable 
competition which the northern medical schools 
hold with the munificently endowed institutions 
of the same kind in Europe. They, certainly, 
understand the diseases of their own climate, 
much better than we of the south do. But in 
turn, something is due to our own experience 
and observation, in our appropriate diseases. 

The medical profession of the south, is with- 
out character ; and consequently, respectability 
and reputation. These are to be obtained, only 
by combination; the liberal patronage of our 
state legislatures, and by the erection of medi- 
cal schools among us. The examples set by 
the legislatures of Virginia and South Carolina, 
are as commendable for their policy, as lauda- 
ble for their liberality. 



OBSERVATIONS 

UN THE 

TOPOGRAPHY OF SAVANNAH 



Savannah stands upon a plain, on the south 
side of the river of the same name, about 
twelve miles in a direct line from the ocean. 
This plain, elevated some forty feet above low 
water mark, is composed of sand, with here and 
there a narrow vein of clay running irregularly 
through it. In some places, beneath the surface, 
the sand is discoloured by iron. It is believed, 
that there is not an equal elevation so near the sea, 
between New-York and the Isthmus of Darien. 
Fine water is o*>ra ned, by penetrating twenty 
to thirty feet in the sand. From east to west, 
the bluff extends along the river, upwards of a 
mile ; terminating abruptly at either extremity. 
There is a very gentle and regular declivity, to 
the south, for several miles. Opposite the city, 
lies Hutchinson's Island ; the soil of which is 

C 



18 



OBSERVATIONS ON THE 



alluvial; and in the language of the country, is 
called tide swamp : that is, it is subject to inun- 
dation, by the ordinary spring tides ; and is well 
adapted, in consequence, to the cultivation of 
rice. The city is bounded on the east, and 
west, by similar lands. The ordinary elevation 
of the tides opposite the city, is about eight feet. 
The salt water approaches usually, within four or 
five miles of Savannah : when the river was low in 
1818, it came to within about half that distance. 
Soon after passing the city, in its course to the 
ocean, the river is divided into numerous chan- 
nels, by small islands of marsh; the beautiful 
and delicate green of which, interspersed in the 
waters, affords, when viewed from the north- 
eastern extremity of the bluff in a summer's af- 
ternoon, one of the softest scenes which I have 
ever beheld. The Carolina shore affords a 
large body of very valuable rice land, most of 
which is in a state of cultivation. 

By the storms of 1804 and 1824, these lands 
were placed from six to ten feet under water, 
and sustained great damage by the destruction of 
crops, houses, dams, &c. In many of these 
plantations, are found mounds of a very rich and 
black earth, elevated, some as much as ten and 
twelve feet, which afford secure retreats during 
these gales and inundations. Upon some of 
these mounds, there are trees evidently the 
growth of centuries. They are not confined to 



TOPOGRAPHY OF SAVANNAH. 



19 



the banks of the river, but are usually consider* 
ably removed, sometimes more than a mile, from 
them. Pieces of earthern vessels, such as are 
supposed to have been used by the Aborigines, 
are frequently found upon them ; sometimes, 
these mounds occupy an extent of several acres, 
and afford sites for barns and stacking places for 
rice, beyond the reach of any storm ; thereby 
adding much to the value of a plantation. In 
passing up the river, these mounds become 
larger and more numerous, than nearer the sea. 
Experience has shown, that residences upon 
these mounds are more sickly, than on the ad- 
joining low grounds. It is equally true, that 
settlements upon the river bank, are more 
healthy than those farther removed. 

The city of Savannah is open and spacious, 
being divided by numerous and wide streets and 
lanes, intersecting each other at right angles, 
with large squares at regular distances. Its 
plan is certainly better adapted to a warm cli- 
mate than any that I have ever seen. Our ele- 
vation above the adjacent country, and the open 
plan of our city, give us the advantage of a 
pretty regular sea breeze in summer ; and our 
heat, though from its long continuance, it is 
much more debilitating, is by no means so op- 
pressive, as in other cities to the north of us. 
Upwards of twenty years ago, the Pride of India 
was planted in al) our streets and squares. 



20 



OBSERVATIONS ON THE 



— These have afforded us a shade in summer, 
the value of which cannot readily be appreciated 
abroad. 

Many of these were uprooted or dismantled 
by the storm of 1824 : and in many places the 
water oak has been substituted tor them. Be- 
lieving that no tree can, in this soil, sustain itself 
against a storm, such as that of the last year ; I 
am fearful that, at some future day, when these 
oaks shall have attained their full size, the recur- 
rence of another storm, by beating them upon 
our houses, will do incalculable mischief. The 
Pride of India is so light, and yields so gradually 
to the gale, that it produces little or no injury, 
when thrown against even small wooden houses. 
It will be obvious at once, that there is not in 
the character of our soil, nor in our situation, 
any thing to preclude us from the enjoyment of 
health; and, that whatever causes of disease 
may exist, are within our own control. It was 
under this impression, that a number of en- 
lightened and philanthropic gentlemen of this 
place, long since conceived the idea of cutting 
off the sources of fever, which existed around 
our city, by changing the cultivation of the low 
lands, from a wet to a dry kind. 

It was known, that whilst these lands remained 
in a state o( nature, they were unproductive of 
disease, and that some seventy-five years ago, 
as I have been informed by Dr. Jones, Savannah 




TOPOGRAPHY OF SAVANNAH. 21 



was resorted to in summer, by some of the inha- 
bitants of Charleston, on account of its salubrity. 
In 1817, at a town meeting, it was resolved that 
about seventy thousand dollars should be appro- 
priated by the city, to the purchase of the right 
of cultivation in wet culture, of such of the tide 
swamps as were adjacent to the city. These 
lands were accordingly subjected to a dry culture, 
by contract, at the price of forty dollars per 
acre ; and the system went into operation the 
following year. Its success at first, surpassed 
the expectations of its warmest friends The 
want of attention to the cleanliness of the city; 
the introduction of a labouring class of whites, 
unaccustomed to our climate ; the great mortality 
of 1820; the reputed unproductiveness of the dry 
culture lands, with other circumstances, gra- 
dually, brought the system into considerable dis- 
repute ; and in 1821, it was determined that the 
propriety of continuing it, should be decided by 
a vote of the citizens. Upon counting the bal- 
lots, the majority in favour of its continuance 
was only sixty-nine votes. Those opposed to the 
dry culture system, now became more clamorous 
than ever. About this time, new efforts were 
made to sustain the system : a new train of 
measures was adopted ; a board of health, which 
had been previously established, took under its 
special care, the condition of our streets, lanes, 
&c, and great attention was paid to cleanliness. 



22 



OBSERVATIONS ON THE 



The proprietors of the dry culture lands, were 
gradually induced to pay more regard to their 
contracts. One of the largest tracts, and imme- 
diately opposite to the city, came into the pos- 
session of T. Spalding, Esq. of Darien, who 
placed it at great labour and expense in ver} r 
fine order. His example was followed by several 
of the other contractors; and most of these lands 
are now in good condition. Its benefits being 
most obvious, public opinion is now almost 
unanimous in favour of the dry culture system. 

It has been already stated, that the great mor- 
tality from the yellow fever of 1820, aided in 
bringing the dry culture system into disrepute. 
The production of this epidemic having been 
attributed to various causes, it may not be amiss 
to point out its real sources. In the first place, 
it will be proper to remark, that during a few 
years previous to 1820, a very great number of 
labouring foreigners, and especially Irish, came 
to the United States. The large cities to the 
north were soon thronged with them. The 
commercial embarrassments which occurred 
soon after, diverted many to the south ; and a 
large number located themselves in this city. 

White porters and draymen, were unknown 
in Savannah, previously to the winter of 1818- 
19. Very many arrived in August and Sep- 
tember of the latter year ; almost all of whom 
speedily became victims to the climate. In the 



TOPOGRAPHY OF SAVANNAH. 23 

winter of 1819-20, our city was literally thronged 
with them. Every tenantabie house was crowd- 
ed. The great fire of January, 1820, dispos- 
sessed very many of them, of their trail homes. 
These were necessarily driven in upon their 
countrymen ; and frequently two and three fami- 
lies were found in small houses of one story, 
with but two small rooms ten or twelve feet 
square ; in one of which the occupants cooked, 
washed, and ate ; and slept in the other. 1 have, 
elsewhere, adverted to the inattention of the 
police to cleanliness. The filth was greatly in- 
creased, by these crowded families It was in 
the eastern and western extremities, where 
these people mostly lived, that the fever made 
its appearance. In the central southern part 
of the city, which had been recently built up, 
and where there was none of this crowded 
population, no case ot fever appeared during the 
whole season. 

There is no doubt, but that the decayed con- 
dition, in which many of the small buildings 
were, also contributed, though very subordi- 
nate^, to the causes of disease. My own ob- 
servation of the extreme filthiness of these 
over-peopled portions of the city, is fully con- 
firmed by the report of a committee of the Geo. 
Med. Society, who examined them. Three of 
the four physicians, who composed that com- 
mittee, died in the course of the season. The 



24 



OJBSEKVATIONS ON THE 



other, (the respected president of that society,) 
from domestic afflictions, left the city. The 
ruins, occasioned by the fire of that year, have 
been by many considered as causing the dis- 
ease These were in the northern central por- 
tion ; in the neighbourhood of which, the cases 
of fever were by no means comparatively so 
numerous, as in the eastern and western sec- 
tions. In the absence of our new population of 
foreigners, the causes of disease as they existed 
would no doubt have produced great mortality ; 
but it is certainly true, that that population af- 
forded near three-fourths of the whole number 
of deaths. 

Whilst many adduced the fact of the mortality 
of this season, to prove the inefficiency of the 
dry culture system, a faint effort was made to 
induce a belief that it was the cause of the dis- 
ease. Either opinion is, however, equally er- 
roneous, as has been since proved by ample ex- 
perience. 

Within the last fifty or sixty years, there has, 
according to the early records of the colony, 
been a material improvement in the depth of the 
river and bar. Attendant upon this deepening 
of the river below the city, there has been a 
recession of the salt water ; and lands formerly- 
unproductive from its presence, are now culti- 
vated in rice, cotton, and corn. It is also evi- " 
dent, from the remains of dams and canals, that 



TOPOGRAPHY OF SAVANNAH. %£> 

some rice lands, east of the city, which are now 
flowed from the river, were formerly irrigated from 
reservoirs formed upon the more elevated grounds 
behind them. These dams are still pretty perfect 
upon the lands of the cedar grove plantation, 
presented to the late Gen. James Jackson, by 
the state of Georgia, in consideration of bis re- 
volutionary services. This plantation, with some 
adjoining lands, was formerly owned by the co- 
lonial Governor Wright, who is still reputed to 
have been one of the most successful planters 
in this province, in his time. The late Richard 
Proctor, Esquire, of May River, has been fre- 
quently heard to say, that, in his occasional 
visits to this place, previous to the revolution, 
he has often seen Governor Wright examining 
the water at the mouths of his canals, to ascer- 
tain if it was sufficiently fresh to be let in upon 
his rice. This information, I received from Major 
Screven, a connexion of Mr. Proctor's, to whom 
I am also indebted for the fact, of the existence 
of the dams and canals, for the purpose of 
flowing the swamp lands from reservoirs behind 
them. 

It would appear, from the information which 
I have been enabled to obtain, that whilst the 
bars at the mouths of the short rivers, south of 
Cape Hatteras, become gradually more and 
more shallow, those of the long rivers, gra- 
dually deepen. The consequence of which is, 

D 



§D OBSERVATIONS ON THE 

that whilst in the former rivers, the salt water 
advances up them, in the latter it recedes. This 
much is certain, that lands at one time cultivated 
on the former, and irrigated by their waters, are 
now rendered unproductive by the presence of 
salt water; and that lands on the latter, formerly 
unproductive from the presence of salt or brack- 
ish water, are now cultivated, and when occa- 
sion requires, are irrigated from them. 

In consequence of the great mass of rubbish 
cast upon our streets, in rebuilding, after the 
fire of 1820, their sandy character of soil was 
destroyed for a time. Fortunately, however, 
for us, the sand is again becoming more and 
more predominant ; and in two or three years, 
ho trace of that rubbish will be observable. 
The presence, or rather the predominance of 
this sand, is of vast importance ; for it readily 
absorbs the rains which fall ; but for which, from 
the great evenness of our streets, it would be- 
come stagnant, unless drained, and in that way 
be injurious to our health. An effort was made 
some years since, to graduate our streets, so as to 
enable them to cast off the water as it falls. This 
effort has (as all such others must) failed. When 
I settled in Savannah, ten years ago, so perfectly 
porous was the soil of the streets, that water 
never remained forty-eight hours after its fall ; 
and under the system at present pursued, this 
will very soon be the case again. Such a con- 



TOPOGRAPHY OF SAVANNAH. %7 

dition of our streets is certainly much more con- 
ducive to health, than could be any character of 
pavement. 

The winter climate of Savannah is mild, and 
the atmosphere soft and elastic. My own ob- 
servation, which is amply confirmed by the ex- 
perience of numerous invalids, has convinced 
me, that the immediate climate of our city, is 
much more favourable to consumptive patients 
than any other in the southern states. 

Elevated above the adjacent country : situated 
upon a dry sandy soil, and the cultivation of rice 
in its immediate vicinity restrained, Savannah will 
be considered as enjoying advantages for health 
superior to any southern city ; and it must be- 
come a place of summer retreat for those re- 
siding in its vicinity, whether upon the sea shore 
or in the interior, as it was some seventy years 
ago. 

Subjoined is an extract, from a Meport made by 
the Dry Culture Committee to the City Coun- 
cil, early in 1824. 

" Six years have now passed away, under the 
operation of the dry culture system. Imper- 
fectly as that system has been enforced, it has 
given proofs, the most conclusive, of a favoura- 
ble influence upon the health of Savannah. It 
is the object of your committee, in their report, 



2§ 



OBSERVATIONS Otf THE 



to refer to these facts ; and to show by them, 
how important it is that the city council should 
persevere in rigidly enforcing the dry culture 
contracts ; and, to pursue, by all lawful means, 
those, who alike regardless of their engagements 
with the city, and the dictates of humanity, set 
at nought the deep and permanent interest of 
the community, in which they live, and to which 
they are indebted for the protection of their 
property. It cannot have escaped the attention 
of the most careless observer, that since the in- 
troduction of the dry culture system, our sum- 
mer and autumnal atmosphere has undergone a 
great and favourable change in its sensible quali- 
ties. The fogs which heretofore rising from the 
lands, now subjected to the dry culture system, 
and penetrating to the heart of our city, gave a 
high degree of humidity to our atmosphere, 
have since disappeared, and with them that hu- 
midity. Heavy fogs, may now occasionally, in 
an autumn morning, be seen rising from lands 
cultivated in rice. Sometimes, they approach 
the eastern and western ends of the city, but 
do not advance further. During the long flow, 
which was made the last season, upon the rice 
fields recently opened upon the southwest ex- 
tremity of the city, the atmosphere became more 
heavy, and damp, and in a short time a very dis- 
agreeable stench was remarked by the inhabit- 
ants of that portion of the city ; the trunks 



TOPOGRAPHY OF SAVANNAH. 



29 



conveying the water to the rice suddenly gave 
way, and the putrid water escaped its confine- 
ment, before the trunks could be repaired. The 
offensive stench was not perceived after this. 
Previous to the introduction of the dry culture 
system, such was the humidity of the atmos- 
phere of this city, during the long flow upon the 
rice, that a person after being exposed for a short 
time at night, could wring water from the locks 
of hair hanging below his hat. Now, through- 
out the whole season, there is a dryness and 
an elasticity of atmosphere, the very reverse 
of what existed previously. It will be obvious 
that this great improvement in the sensible 
qualities of our atmosphere, must be salutary to 
those who breathe it. Previous to the intro- 
duction of the dry culture system, the Bay was 
as notoriously the most unhealthy part of the city, 
as that portion of the city lying south of South 
Broad-Street, was then the most healthy. The 
reverse now obtains, and from causes equally 
obvious. The bay, from its proximity to the lands 
subjected to the dry culture system, is most im- 
mediately under the influence of that system ; 
and its improved salubrity, is one among the 
many unequivocal evidences of the agency 
of the latter, upon the health of Savannah. 
Whereas, that portion of the city south of South 
Broad Street, formerly furthest removed from 
the cultivation of rice, has within the last three 



30 



OBSERVATIONS ON THE 



years, been thrown more immediately under the 
influence of wet culture, by the opening of an 
extensive rice field, immediately to the south- 
west." 

Unimportant, as at first it may seem, your 
committee cannot omit alluding to the greater 
appearances of health, as indicated by the coun- 
tenances of our inhabitants, during the summer 
and fall, for the last three years. 

It is an evidence of a more vigorous health, 
than before prevailed, even among those of 
our inhabitants, who escaped positive disease. 
Nothing formerly was better calculated to im- 
press upon the mind of a stranger, arriving here 
in November, the melancholy character of our 
climate, than the blanched faces of our inhabit- 
ants. 

The remark is now general, with those who 
have had opportunities of observation, that of 
late, the faces of our inhabitants are quite as 
indicative of health, as those of persons residing 
in cities to the north, reputed much more salu- 
brious. With this improved healthy appearance, 
there has certainly been united a greater corpo- 
real vigour. Unequivocal, however, as these 
evidences of the improved healthiness of Sa- 
vannah must be, there is yet another character 
of testimony, which places the question abso- 
lutely above cavil. Your committee refer to the 
records of mortality; by comparing the number 



TOPOGRAPHY OF SAVANNAH. 31 

of deaths, and the population in different years, 
it can be readily ascertained, in what years, 
the proportion of the former to the latter, has 
been greater ; and hence, can be learned with 
great precision, the comparative unhealthiness 
of any two years. It is true, that there are no 
absolute data, showing the exact population of 
the different years ; yet, there is a remedy, 
ample for all purposes. Your committee have 
multiplied the number of votes, polled at each 
election for Aldermen, on the first Monday 
in September, in each year, by six, upon the 
supposition that one-sixth of our population are 
voters. It is not material, however, to the accu- 
racy of the calculation, that, that should be the 
precise proportion : it is sufficient to know, that 
the proportion of the voters to the whole popu- 
lation is, one year with another, very much the 
same. 

As the coloured population is not embraced 
in the bills of mortality, so it is not designed to 
include it in the estimate of our population. By 
this estimate, it will appear, that the proportion 
of persons dying of autumnal diseases, to the 
whole white population, is as follows : 




1815, 1 in 15. 

1816, 1 in 18. 

1817, 1 in 9f. 



32 OBSERVATIONS ON THE 



1818, 1 in 62f . 

1819, 1 in 13. 

1820, 1 in 5 to. 

1821, 1 in 37. 
iS22, 1 in 33f. 
1823, 1 in 32*. 

This estimate* it will be perceived, embraces 
a period of nine years ; the first three of 
which passed previous to the introduction of 
the dry culture system, and the average of those 
years may be deemed a fair estimate of the ha- 
bitual mortality, occurring in the population of 
Savannah, for many years previous, or about 
one in eleven. The second term embraces a 
remarkable period, in the history of Savannah. 
That of 1818, the commencement of the dry 
culture system ; when the lands subjected to 
it from their cultivation in rice, the preceding 
year, were in excellent condition, for a fair ex- 
periment of the scheme ; and it may safely be 
said, it has been the only year, in which a fair 
and full trial has been made. The following, or 
1819, is remarkable for the addition of a labouring 
class of whites, to our population, and it is a 
melancholy fact, that a large number of them 
arrived during the months of July, August, and 
September, a very large proportion of winch 
fell victims to our climate ; and thus, swelled the 
bills of mortality. To our permanent population. 



T0P6GRAPHY OF SAVANNAH. Sti 

this was certainly a healthy season. The year 
1820 is remarkable for the ravages of the yellow 
fever, to an extent seldom witnessed elsewhere ; 
the causes of which have not yet been satisfacto- 
rily explained to the public. The average pro- 
portion, for these three years, is about one death 
to every twenty-seven for each year. The ave- 
rage for the last three years, of this term, is about 
one death in every thirty-four of our population^ 
for each year ; which, if compared with the last 
three years, that elapsed previous to the introduc- 
tion of the dry culture system, is incontestable evi- 
dence of the advantages of that system. In insti- 
tuting this comparison, there is, however, one fact 
of too much importance to be omitted. Your com- 
mittee allude to the new feature which has been 
given to our population, since 1818, by the in- 
troduction of a white labouring class, unaccus- 
tomed to our climate, and in a great measure, 
ignorant of its danger ; certainly, unacquainted 
with the prudential measures usually adopted 
to guard against disease, and especially subjected 
by their pursuits, to all its force. It is estimated, 
that this population, upon an average, for the 
last three years, has been equal, during the 
summer season, to about seven hundred, or up- 
wards, of one-fifth of the white population ; and, 
that the deaths occurring in it, from summer 
and autumnal disease, are equal annually, to 
three-fifths of the whole number of deaths of 



84 



OBSERVATIONS, &C. 



the same population. Then, it will be seen, that 
whilst a new character of population, inconsi- 
derable, when compared to the whole, sustains 
three-fifths of the deaths of the whole ; still, the 
mortality of Savannah, under the dry culture 
system, is one death in every thirty-four ; when 
the mortality previous to the adoption of this 
system, and previous to the introduction of that 
population, was, one death to every eleven, of 
the white population, annually. 

From these statements, it will be sufficiently 
obvious, that, the dry culture system exercises 
a very important and a highly salutary influence 
upon the health of Savannah ; and, that it is 
imperiously the duty of every good citizen to 
unite zealously in the support of a measure, so 
fraught with blessings to the community in which 
he lives. 

For the last two seasons, (those of 1824-5) 
there has been a further and a material improve- 
ment in the health of Savannah. The latter year 
may be considered full as healthy as that of 1818, 



ON THE 



AUTUMNAL FEVERS 

OF 

SAVANNAH. 



Although, not exclusively the production of 
that season, I prefer the term autumnal, to de- 
signate our marsh miasmatic fevers ; because, 
whilst it is sufficiently distinctive for all my pur- 
poses, it is free from theoretical objections. 
Under autumnal, then, I embrace the inter- 
mittent, remittent, continued, and yellow fevers. 
Each of them assumes, under some circum- 
stances, more or less, the type of the others. 
Arising from similar, or modifications of the 
same cause, assailing the system, through the 
same avenues, and subjected to the same rules 
of treatment, they may be considered as essen- 
tially the same disease ; modified only, by dif- 
ference in degree of cause, and condition of 
system. Most writers, who have considered 
these diseases specifically different, have inci- 
dentally recited facts violative of their own sys- 
tems. Desportes, (always correct in the detail 



36 



AUTUMNAL FEVERS 



of symptoms,) in his history of the diseases of 
St. Domingo, described the yellow fever (then 
called mal du Siam,) as a distinct and specific 
disease, propagated by contagion. He considers 
the double tertian, as the appropriate disease 
of that Island, arising out of local causes. He 
afterwards remarks, that "the mal du Siam is 
complicated with the double tertian, when there 
is not morbific matter sufficient to generate the 
mal du Siam." 

This latter, he divides into three varieties, 
according to the intensity of the disease. The 
first, he calls mild ; the third malignant ; and the 
second, he places intermediately, between the 
first and third. The late Dr. Rush, equally sys- 
tematic, has certainly run into the other ex- 
treme. It must be obvious to every reflecting 
and experienced physician, that his success, as 
recorded by himself, was far greater than could 
have attended upon the treatment of unequivo- 
cal cases of yellow fever. Numerous facts may 
be gleaned from his own writings to show, that 
many of the cases which he called yellow fever, 
bore in reality, a much milder character ; and 
which, had they occurred at a different time, 
would not have created any apprehension. He 
misapplied an observation of Sydenham, that 
the prevailing disease of a period, gives its livery 
to others of a milder character. 

The original observation is no doubt correct ; 



OF SAVANNAH. 



37 



but there has been an error in its application by 
Dr. Rush. Sydenham referred to the control 
which one disease exercised over another, spe- 
cifically different, as the small-pox, or dysentery, 
over fevers prevailing at the same period. Rush 
applied the remark to varieties of the same dis- 
ease ; and in this, he not only erred, but violated 
the opinion so frequently and strongly enforced 
by himself, that autumnal fevers differ only in 
degree. Nothing is more common in hot cli- 
mates, than the coexistence of two grades of 
fever, essentially different in the degree of their 
violence, and in the character of their subjects. 
Whilst a mild intermittent prevails among the 
natives and old inhabitants of a district, the 
yellow fever confines itself to strangers. This 
fact is repeatedly admitted by Desportes and 
other writers upon the diseases of tropical cli- 
mates. I have witnessed the same here, and it 
was particularly striking in 1817. In the autumn 
of that year, a mild tertian prevailed extensively 
among the old and native inhabitants. The 
disbanding of M'Gregor's followers, after their 
attack upon Amelia Island, together with the 
arrival of several vessels from Europe and the 
northern cities, about the latter part of Septem- 
ber, and of many more in October, suddenly in- 
troduced a number of persons, unaccustomed to 
our climate, in the most fatal period of the sea- 
son. Among these the yellow fever became 



38 



AUTUMNAL FEVEHS 



epidemic, and continued until checked by frost, 
which took place about the 22d of November. 
Neither of these diseases appeared to affect 
or influence the other. 

It is probable, that all our autumnal fevers, 
are modifications of the simple tertian. It is 
presumed, that some one of them must be pri- 
mitive to the exclusion of the others. That cer- 
tainly should be so viewed, to which the others 
appear most closely to approximate, and into 
which the others are most frequently resolved. 
With us, an autumnal quotidian, is unusual. 
Quartans are of full as rare occurrence. Simple 
and double tertians are habitually the prevailing 
intermittents. 

Remittent fevers habitually exhibit here, fiercer 
exacerbations upon alternate odd days. If, as 
however occasionally obtains, there should not 
be this obvious difference in the severity of the 
exacerbations, then the exacerbation of one day 
will probably be in the morning, and that of the 
following in the evening ; thus still assuming the 
tertian character. Continued fevers have not, 
within my observation, been common here ; and 
certainly, they are becoming more and more, of 
rare occurrence. 

Although some cases of yellow fever annually 
occur, I have known it endemic but two years, 
viz. in 1817 and 1820. The cause of its preva- 
lence these years, can be readily explained with- 
out resorting to contagion. 



OF SAVANNAH, 



39 



The following is an extract of an anniversary 
oration, delivered before the Georgia Medical 
Society in February, 1818, which explains the 
causes of the great unhealthiness of the preced- 
ing season : " Although, in the commencement 
of the last summer, nothing unusual w as observed, 
it had not advanced far, before a train of events 
occurred, by no means auspicious. Instead of 
occasional showers, which are usual at that pe- 
riod of the year, we had frequent and heavy falls 
of rain for successive days, alternating with an 
intensely hot sun, with considerable regularity, 
until near the close of summer. Soon after the 
commencement of this weather, our city council 
turned their attention to the levelling of our 
streets, contrary to the express objection of 
several medical gentlemen. In this process, 
the refuse and offal of our vards and kitchens 
(which, for years, had been permitted to accu- 
mulate gradually in mounds, where they were 
comparatively innoxious) were, with a prodigal 
hand, distributed upon- the streets, and subjected 
to the influence of the heat and moisture of that 
season. In addition, earth was deposited in the 
depressions of the streets and lanes, for the pur- 
pose of levelling them ; which mingling with the 
fallen rains, produced numerous muddy and of- 
fensive places." 

It has appeared to me, somewhat extraordina* 
ry, that the action of all idiopathic feyers, should 



40 



AUTUMNAL FEVERS 



have been considered capable of explanation 
upon the same principles. It is certainly an 
evidence of a very strong propensity to general- 
ize, that the fevers of middle latitudes, and those 
of the arctic regions, that the fevers of a northern 
winter, and those of a tropical summer, that the 
fevers produced by heat, and those caused by 
cold, should all be considered capable of the same 
physiological solution. Certainly, nature does 
not authorize the alliance between these dis- 
eases, which has been forced upon them by sys- 
tematic writers. And may not this generalization 
of fevers, so different in their causes, their symp- 
toms, and their seats, account (at least in some 
degree) for the imperfect explanations which 
have been given of at least some of them ? If the 
same causes (other circumstances being equal) 
produce the same effects, it is equally true, that 
different causes produce different effects ; yet 
systematic writers have all (I believe) committed 
a twofold violation of this rule. They have first 
attributed to obviously different causes, the same 
effects in the production of fevers, by supposing 
all idiopathic fevers to have the same proximate 
cause, (which proximate cause is certainly an ef- 
fect,) and secondly, they have given a common 
explanation to the phenomena of fevers obviously 
different in their characters, as well as in their 
causes. 

There is, perhaps, but one circumstance com- 



OF SAVANNAH. 



41 



mon to all fevers, namely, a disordered circulation; 
which, to some extent, obtains in all acute dis- 
eases, and might, with equal propriety, be cited 
in justification of a theoretical explanation of the 
nature of such diseases, upon one common prin- 
ciple ; as it authorizes the supposition, thatall 
idiopathic fevers, are capable of the same expla- 
nation. There is about as much propriety in 
Rush's doctrine of the unity of diseases, as there 
is in the opinion of a common proximate cause 
for all fevers. In admitting that different fevers 
arise from dissimilar causes, systematic writers 
authorize the inference, that such fevers are 
intrinsically different in their natures, and con- 
sequently incapable of explanation, upon any 
one general principle. The causes of fevers 
being different, the impressions which they make 
upon the system, may be as various as the fe- 
vers which they produce, and the media by 
which they operate. Few opinions have, per- 
haps, been so generally adopted, which have 
less foundation in fact, than the one that each 
year produces a new disease, and that marsh 
miasmatic epidemics, occurring at different pe- 
riods of time, in the same locality, are essen- 
tially different. Without pursuing this subject 
generally, I now inquire, in what consists the 
difference between the autumnal or marsh mias- 
matic fevers, of all countries ? Referring to the 
history of medicine, we find the same charac- 

F 



4? 



AUTUMNAL FEVERS 



terizing symptoms to prevail at all periods, and 
at all places, where the disease is known. In- 
deed, some of the most accurate descriptions of 
autumnal fevers, are to be found among the 
ancient writers. It is not pretended that these 
diseases do not assume, at times, a milder or a 
graver character ; but, this is equally the case 
with the small-pox and other specific diseases ; 
and, it is not claimed, that these are ever capa- 
ble of essential or important modifications, from 
time and place. I mean only to insist, that the 
causes, the character, and the seats of autumnal 
fevers are ever the same, and consequently, 
always should be subjected to the same princi- 
ples of treatment. The type of the fever can- 
not affect the character of the remedies to be 
used in its cure. It will not be contended by 
me, that erroneous methods of treatment may 
not essentially modify the disease, as well as 
overturn the energies of the system. 

It is an undeniable fact, that previously to the 
introduction of the depleting and mercurial treat- 
ment in the fevers of this place, and long after 
the cultivation of rice in our immediate vicinity, 
our fevers were decidedly intermittent in their 
type ; and that, during that practice, (which may 
be considered to have terminated in a great 
measure, with the season of 1822,) they gene- 
rally assumed a more or less perfect remit- 
tent or continued type. J know that much in- 



Oh' SAVANNAH. 



dustry is used, by those most interested in the 
question here, to impress the belief that the in- 
termittent type of our fevers now is the effect 
of the dry culture system. It has been hereto- 
fore stated, that this system was most completely 
in operation in 1818 ; and that certainly was by 
far the most healthy season we have had in ten 
years ; but, it is not contended, nor can it be 
with any propriety, that the fevers of that sea- 
son, were intermittent. At that time, the de- 
pleting and mercurial system, was in full vogue 
among us. In 1821 and '22, we enjoyed much 
health, but our fevers were not usually of the 
intermittent type. Active purging and salivation 
were then resorted to, by most of our physi- 
cians, although their zeal had been evidently 
abated by the miscarriages of 1820. There is 
another fact which, I presume, many of our citi- 
zens know familiarly, that the poor who reside 
upon the extreme east and west of our city, 
(the most unhealthy locations) suffer chiefly 
from intermittent fevers. 

These receive very little medical attention, 
unless when sought out by charitable persons ; 
for it is a fact, that our native poor will not beg : 
they will allow themselves to be relieved by 
those who seek them, but will neither solicit 
alms, nor the gratuitous services of our physi- 
cians. The intermittent type of their fevers is 



44 



AUTUMNAL FEVERS 



attributable to their being left to the resources 
of nature. 

There are but few matters of opinion upon 
which my convictions are more clear, than that 
the intermittent and remittent type of our fevers, 
may be influenced by active and drastic purgings. 
Such means increase very much the tendency of 
blood to the internal parts, counteract the efforts 
of the internal capillaries to relieve themselves, 
by throwing off the excess of blood cast upon 
them, and by overpowering, impair their vigour. 
I well know, that this is a point upon which phy- 
sicians may fairly differ, as it cannot be subjected 
to absolute proof ; for, upon the supervention of 
a fever, no one can say, with certainty, what will 
be its type. Upon the introduction of the anti- 
phlogistic and mercurial treatment in the United 
States, the intermittent type certainly became 
less common ; and within a few years, and since 
the modification or abandonment of that system, 
they have certainly become much more frequent. 
I do not design to say, that all autumnal fevers 
are intermittent ; for it is well known that such 
is not the fact, nor do I mean to deny, that other 
causes, independent of the treatment, affect their 
type. Whatever be that type, the nature ot the 
fever is the same, and the same means of treat- 
ment are necessary and proper. To me, it is 
evident, that the autumnal fevers, described by 
Sydenham, are essentially the same with those 



OF SAVANNAH. 



4$ 



which have at all periods occurred in the south 
of Europe, and in the United States: their 
more protracted course may , I think, be readily 
explained by the circumstance of treatment. 
Whilst active evacuations precipitate the issue 
of fevers, or whilst an active tonic treatment 
speedily terminates them elsewhere, the method 
of cure adopted by that great man, comparatively 
left the disease to the tardy efforts of nature, par- 
tially supported by his prescriptions. Others may 
have been more fortunate, but I must acknow- 
ledge, that I have not been enabled to discover 
any essential difference between his fevers, pre- 
vailing in different constitutions (as he terms 
them,) of the air. Following the suggestions of 
Sydenham, Rush has also given us an account 
of the marsh miasmatic fevers of different years, 
which certainly have no important peculiarities. 
I have adduced the names of these two great 
men, because they have, (I feel) by their autho- 
rity, essentially aided in propagating and perpe- 
tuating an error. Among the circumstances 
upon which reliance has been placed, to prove 
the dissimilarity of autumnal fevers of different 
years, much importance has been attached to 
the appearances upon dissection, when the dis- 
ease has been unusually fatal or severe. Phy- 
sicians have been led into error on this point, 
because they have not usually made similar in- 
vestigations in other seasons, when the disease 



46 



A V T 17MNAL EE YE ii S 



has been comparatively mild. I can safely say, 
that for the last four or five years, I have rarely 
permitted an opportunity of examining a sub- 
ject, who died of fever, to escape me ; and I 
never have seen a single instance, in which the 
stomach or bowels, or both, have not presented 
essentially the same appearances, though not 
always so extensive, as in those who have died 
of yellow fever. Confining himself to post 
mortem appearances, no physician can determine 
whether death has been produced by an inter- 
mittent, remittent, or yellow fever. 

The manner in which agents operate in 
producing fevers is yet unexplained; nor is 
it better understood, by what means they enter 
the body, if, indeed, they do so at all. Their 
modes of introduction have been assigned : 
by the lungs, by the stomach, and by the ol- 
factory nerves. If the disease was the pro- 
duct of matter received by either of the two 
first, why does so long a period intervene 
between the introduction of cause and the 
developement of effect? We know of no 
similar delay after the introduction of any 
other offending matter, which when received 
into the stomach, acts almost instantly upon that 
organ. 

It will scarcely be contended, that a person 
fasting, whilst in an infected atmosphere, will 
certainly escape the yellow fever ; and, yet, if 



OF SAVANNAH. 



47 



the disease was produced by matter introduced 
into the stomach, it might be always avoided. 
But it is said, the cause is entangled in the sa- 
liva. If the cause be substantial, it has hitherto 
escaped the investigation of the most dexterous 
chymists. If it is received into the system, 
either through the lungs or stomach, how can 
the fact be explained, that all ages and condi- 
tions are not equally subject to the disease ; and 
why whole classes of people are sometimes 
exempt, when others are peculiarly liable to 
fevers? We know of no agent, which, when 
introduced into the system, affects one portion 
of the human race, to the exclusion of another ; 
and such a supposition would certainly appear 
very unphilosophical. The opinion that the 
disease is received through the olfactory nerves, 
has, I believe, but few advocates ; and it does 
not appear probable, that their number will be 
augmented. It has appeared to me far more 
reasonable to suppose, that autumnal fevers are 
produced by qualities imparted by marsh miasma, 
to an atmosphere, which, thus impressed, impairs 
the capillary action of the skin,* and affects the 
equilibrium of the circulation ; the destruction 
of which creates an effort in the internal capil- 
laries, now surcharged, to relieve themselves, 
which reaction constitutes fever. The character 



*See Cullen's First Lines. 



48 



AUTUMNAL FEVERS 



of the fever, (other circumstances being equal,) 
and consequently the speedy production of the 
disease, depend essentially, upon the force of 
cause applied. In some instances, the destruc- 
tion of the external capillary action is so com- 
plete and sudden, and the superficial blood so 
immediately thrown in upon the internal capilla- 
ries, that the system is capable of no reaction. 
In such cases, the patient dies in what is termed 
the cold stage. Some years since, autumnal 
fever appeared in the interior of the southern 
states, under the above circumstances, and was 
in many places denominated the " cold plague." 
In such cases, the prospect of relief to the pa- 
tient, was in proportion to the success of the 
physician in his endeavours to produce a reac- 
tion in the system. The cholera of India is 
produced by the combined action of the chilling 
winds of the night, and of the miasma, throwing 
the blood suddenly in upon the capillaries ; and 
the success which has attended the use of the 
nitric acid bath, is attributable to its exciting 
the external capillaries to vigorous action ; and, 
I have no doubt, but that, if the whole body was 
immersed in it, instead of the legs only, it would 
be much more salutary than by the present 
mode it is found to be ; inasmuch as the cura- 
tive process in this whole family of diseases 
consists in restoring action to the capillary sur- 
face, the consequent equalizing the distribution 



OF SAVANNAH. 



49 



of blood, and the invigoration of theTforces of 
the system, by imparting tone to them. The 
capillary system may be divided into two parts, 
the external and internal. The first is composed 
of those of the skin, and those of the mucous 
membranes : the second, of all the other capil- 
lary vessels. Upon a vigorous exercise of the 
functions of the external capillaries, depends the 
due distribution of the blood ; and, to their im- 
perfect action is attributable, congestions,* and 
enlargements of the various (and especially the 
abdominal) viscera. 

The larger arteries and veins have the simple 
office of circulating the blood ; and I shall speak 
of them, as the circulating vessels. The pro- 
portion of blood which they contain, is habitually 
very much the same. The external capillaries 
are those, upon which agents act, and through 
which the internal are influenced. 

Agents acting moderately, and for a consider- 
able time upon the external capillaries, impair 
the functions of the internal, by casting upon 
them an undue portion of blood. This is illus- 
trated by persons exposed habitually to the in- 

* Asclepiades defined fever to be an extraordinary heat, general or 
local, accompanied by a strong pulse ; the cause of which is often a con- 
gestion, somewhere, as an inflammation. He speaks of obstinate ob- 
struction indicating much danger. He observed the double tertian at 
Rome, as since described by the moderns. He used rubefacients pre- 
pared of mustard. He was contemporary with Antiochus of Astal'orp 
SprengeVs Histoire de la Midecine, vol. iii. 

G 



50 



AUTUMNAL FEVEKS 



tluence of marsh miasma, whereby enlargements 
of the spleen and liver are produced. 

Upon the eastern and western extremities of 
Savannah, there are extensive low damp grounds; 
and those exposed habitually to them, (especially 
if young,) have for the most part, enlarged spleens, 
or livers, or both. Similar enlargements are ha- 
bitual to the w T hite inhabitants of rice plantations. 
Habitual drunkards, and dyspeptic persons, 
have enlarged livers. In all these, the capilla- 
ries of the alimentary canal, have their functions 
impaired. The minute sympathy, subsisting 
between the skin and the alimentary canal, and 
under some circumstances of disease, between 
these and the lungs, is dependent upon the ca- 
pillaries of these organs. In whatever part of 
the system the heat may be generated, it de- 
pends for its full distribution upon the blood 
vessels. Accompanying the blood, wherever 
there is an impaired action in the blood vessels, 
there is a deficiency of heat ; and, wherever 
there is an excessive action, or an unhealthy 
accumulation of blood, there is an augmentation 
of animal heat. This fact, although (I believe) 
generally recognised, does not receive that im- 
portance in the consideration of our fevers, to 
which I have deemed it entitled. In health, 
there is a constant supply, and a constant con- 
sumption of animal heat ; and whilst in disease 
the supply is continued, the consumption is fre- 



Of SAVANNAH. 



31 



quentiy impaired. In health, a very considera- 
ble portion passes off by the surface. In disease, 
this portion is either increased or diminished, 
according to the condition of the capillaries of 
the skin, and the amount of their excretions. 
The causes of fever operating upon the superfi- 
cial capillaries, repel the blood from the surface ; 
whereby the accumulation upon the internal 
capillaries exceeds a certain proportion ; or, is 
thrown in so rapidly, that the capillaries cannot 
adapt themselves to the accumulating volume, 
a reaction takes place in them, by which an 
effort is made to relieve themselves from em- 
barrassment. This process is strikingly illus- 
trated by exposure to cold. The first effect is, 
a paleness of the surface, occasioned by a re- 
cession of the blood from the capillaries of the 
skin; in consequence of which, an unusual 
quantity is suddenly thrown in upon the internal 
capillaries ; these react ; the consequence of 
which is, that not merely the excess of blood is 
cast back upon the superficial capillaries, but 
also a portion of that of the internal, from the 
energy of their reaction, which produces a glow 
upon the surface. In fevers, the injury sustained 
by the superficial capillaries is not immediately 
remedied ; and consequently, the reaction of the 
internal capillaries, does not at once overcome 
the atonic state of the external, and the reaction 
is perpetuated, and the fever continues. In sum- 



52 



AUTUMNAL FEVERS 



mer, agues do not usually usher in fevers ; be- 
cause, the recession of the blood from the su- 
perficial capillaries, is gradual. In autumn there 
is superadded to the course of fever, more or 
less chilliness of the atmosphere, which certainly 
aids in repelling the blood from the surface, and 
casting it more suddenly upon the internal capil- 
laries, producing agues, and which sometimes 
increases the severity of the fevers. Cholera- 
morbus, so common in Baltimore, is owing, in a 
great measure,to the frequent and sudden changes 
of atmosphere, in summer, occasioned by its 
proximity to an elevated country. Fever, as 
has already been observed, is the result of the 
efforts of the interna] capillary system, to dis- 
burden itself of the excess of blood, cast upon 
it from the superficial capillaries. These efforts 
terminate either in the restoration of the equi- 
librium of the circulation, by overcoming the 
torpor in the external capillary system; pro- 
ducing health in the gradual enlargement of 
some of the abdominal viscera, chiefly the 
spleen, or liver ; by which the excess of blood 
is cast upon these organs: and in the partial 
restoration of function to the external capillary 
vessels, producing imperfect health, with chronic 
enlargements, and great predisposition to recur- 
rence of fevers, from very slight causes : or in 
the active and rapid engorgement of the various 
viscera, by the overthrow of the internal capil- 



OF SAVANNAH. 



iary circulation, (the external having been al- 
ready destroyed) in consequence of which, the 
blood is cast where there is the least resistance, 
which is internally : hence, congestions in the 
raucous membranes, hemorrhages, and black 
vomit follow. 

By the superficial capillaries, I mean that net 
work of minute vessels, proceeding from those 
passing through the areola of the cutis vera, and 
composing in a great degree the rete mucosum.* 
The loss of action in the external capillary sys- 
tem in our fevers, is inferred from the loss of 
tone in the skin, which is obvious in every stage 
of the disease. In the cold stage of fevers, slight 
pits are readily formed by gently pressing the 
fingers upon the skin, which gradually subside. 

These pits, in the absence of anasarca, can 
only be explained upon the supposition of an 
impaired action in the capillaries of the part, 
and a consequent reduction in the amount of 
their contents. Throughout every stage of our 
fevers, this condition of the skin exists to a 
greater or less degree, and consequently, at no 
time has it that elastic feel, which belongs to it 
in health. That portion of the skin inflamed by 
a sinapism, in the treatment of a case of fever, is 
frequently obviously elevated in its surface above 

* There is every reason to believe that there is a texture of vessels 
either in the rete mucosum, or between the cutis vera and the rete mucosum . 
Wistar's Anatomy. Sec BichaVs Anatomie, Systeme Dermoids 



54 



AUTUMNAL FEVERS 



the surrounding parts. In the progress of the dis- 
ease, and especially such as terminate in health, 
the adjacent skin is gradually elevated, and the 
inequality, at first so obvious, is removed. There 
is a great tendency in the skin of the hands and 
feet of persons labouring under autumnal fever 
to wrinkle. Dr. Screven suggested this to 
me. The skin of persons in autumnal fevers, 
has frequently been spoken of by writers as lax, 
shrivelled, inelastic, and flabby. In the hot stage 
of fevers, it is frequently dry, rough, and harsh 
to the feel. In such cases, there being no 
moisture upon the surface, the heat accumulates 
there. The cold, clammy, and profuse perspira- 
tions that frequently attend the latter stages of 
fevers, by their evaporation reduce very much 
the animal heat, and consequently add to the 
existing debility. 

The determination of the blood internally in 
our fevers, is inferred from the frequent sigh- 
ing, oppressed breathing, sense of fulness in 
the abdomen, tenderness and pain from pressure 
upon the epigastrium, over the liver and spleen, 
sense of internal heat, restlessness, and above 
all, from the enlargement of the liver and spleen 
observable after death. 

The immediate tendency of the blood cast 
from the capillaries of the surface, is to the 
spleen and iiver. This is fully m;uiiiested in 
white persons habitually residing in the imme- 



OF SAVANNAH. 



55 



uiate vicinity of rice fields, and other low marsh 
or swamp situations,* and especially when re- 
stricted to a scanty or chiefly vegetable diet. 
Such have very pale skins, with more or less 
emaciation, and enlarged livers and spleens ; are 
habitually exempt from severe autumnal fevers, 
and are very liable to the acute diseases of 
winter. Theirs are mild intermittents, some- 
times protracted for many months. They are 
also subject to a chronic feverish habit of body, 
which occasionally scarce yields to the cold of 
our winters. The enlargements of the liverf are 
not so rapid as those of the spleen, nor do 
they usually become comparatively so enor- 
mous. Upon such subjects, the causes of fever 
operate gradually, and they become in some 
measure, habituated to their influence. To a 
person at all attentive to this subject, the aspect 
of an individual is sufficient evidence of the cha- 
racter of his residence ; and that is equally indi- 
cative of the condition of his liver and spleen, 
and especially of the latter. As the blood re- 
cedes from the surface, it accumulates in these 
viscera. Its gradual recession enables them to 
receive it as it is cast in upon them ; hence, 
there is not at one time, a sufficient volume of 

* Rhazes remarked the injurious effects of marshes. Sprengel, vol. ii. 

t Sudden and great enlargement of this organ occasionally takes place 
in children labouring under fever, attended with copious mucous secre- 
tions in the alimentary canal. In such, the enlargement of the spleen is 
considerable also. 



56 



AUTUMNAL FEVERS 



blood thrown suddenly upon the circulating 
vessels to excite severe fever, and the gradual 
adaptation of the internal capillaries to these ex- 
cesses of blood impair their powers of reaction, 
and lessen their resistance to it. Hence, as 
above remarked, such persons are chiefly sub- 
ject to mild intermittents, or remittents, or what 
is perhaps much more common, chronic feverish 
habits. In such, whatever may have been pre- 
viously the condition of the liver or spleen, 
these now become enlarged in the progress of 
these fevers, and especially the latter ; and with 
such immediate enlargements there is at least 
an abatement ; sometimes a subsidence of the 
disease. These enlargements I frequently pre- 
dict to my patients. When the enlargement of 
the spleen is very considerable, a chronic fe- 
verish habit is apt to ensue. In such cases, it 
would appear that there is a constant effort in 
the spleen produced partially by its contractile 
power, but more by the action of the abdominal 
muscles and diaphragm, and the mechanical 
influence of the other abdominal viscera, to re» 
lieve itself of the excess of blood with which it 
is charged, by throwing it into the general circu- 
lation. The reaction in the capillaries of the 
spleen and liver then operate upon the ex- 
ternal capillaries, and the feverish habit is the 
result of this struggle between the two capillary 
systems. 



OF SAVANNAH. 



57 



The return of cold weather divests the atmos- 
phere of its influence in producing fevers, and 
relieves the external capillary system from its 
embarrassment, which now resumes its accus- 
tomed vigor; hence, the spleen and liver re- 
lieved from their excess of blood become less- 
ened in volume, though still maintaining, in warm 
climates especially, a chronic enlargement to 
some extent. Acute hepatitis and splenitis are 
of much more common occurrence in winter and 
spring than in summer and autumn. To such as 
will attend to the intimate relation existing be- 
tween the surface and the liver and spleen, and 
watch its influence in our fevers, I appeal for 
the correctness of my conclusions. This is, 
perhaps, the chief function of the spleen. The 
liver, which is charged with another highly im- 
portant function, appears in our fevers to be 
auxiliary to the spleen, in becoming, in the lan- 
guage of Rush, a reservoir to the system. In 
the former, as well as the latter, I am disposed 
to claim the existence of an erectile tissue. 
This idea has been suggested to me by its ha- 
bitual tendency (in warm climates especially) to 
enlargement. It is the only secretory organ, 
subject to frequent and considerable enlarge- 
ments without great derangement of the system ; 
which are not only unattended by pain, but con- 
tinue occasionally for many years, without appa- 
rently affecting materially the regularity of its 

H 



58 



AUTUMNAL FEVERS 



v secretions. Enlargement of and tenderness 

upon pressure over the liver usually attend dys- 
peptic affections. I have uniformly remarked* 
that an improved condition of the skin, precedes 
their removal ; and I have considered these as 
consequences of the dyspepsia, and produced 
intermediately by the influence of the stomach 
upon the surface. In another modification of 
dyspepsia, a similar influence is certainly exer- 
cised by the stomach upon the lungs. In this, 
many of the symptoms of a true phthisis are 
assumed by the lungs. The true nature of the 
affection is betrayed by the shortness of breath- 
ing, severe cough, and great difficulty in ex- 
pectorating a tough glary mucous, but more 
especially by the appearances of the skin, and 
the general condition of the alimentary canal. 
The term bilious, is now so extensively applied to 
various diseases, as to mean very little more, than 
that the liver in common with other important or- 
gans, participates freely in diseases of the general 
system. A bilious character is, however, espe- 
cially claimed in our autumnal fevers ; and, I be- 
lieve, with as little propriety as in many diseases 
of winter. 

Nothing has done so much towards making 
this term fashionable as the free use of drastic 
purgatives, in most acute diseases within the 
last forty years. Almost any person in health 
may (especially in the summer season,) be in a 



OF SAVANNAH. 



59 



few days purged into what is commonly called 
a bilious habit, by the free use of calomel and 
jalap, and by abstinence. By active purging, 
the blood is diverted to the abdomen ; the liver, 
its largest organ, receives an increased volume, 
and its secretions are augmented. I further 
believe, that persons may (occasionally at least) 
be purged into a fever; and, I think, I have 
seen positive instances of it. That there is 
frequently an increased secretion of bile in our 
fevers, I have no doubt ; and this, I would ex- 
plain in the same way, that I would a total ab- 
sence of bilious secretion, which frequently ob- 
tains in the same disease. So long as the secre- 
tory function of the liver is exercised, the 
quantity of bile is increased by each additional 
amount of blood determined to it ; but, in many 
instances, the volume of blood cast upon the 
liver is so great and sudden, as wholly to over- 
power it in the exercise of its functions, whereby 
the secretion of bile is suspended. This is 
known to occur habitually, in what have been 
rather vaguely called, concentrated cases of au- 
tumnal fever : and habitually, in yellow fever. 
In these cases, free purging will sometimes by 
diverting some of the excess of blood from 
the liver, immediately to other abdominal vis- 
cera, relieve the former from a portion of the 
blood that has overpowered its action, when the 
bilious secretion may be restored ; but, such a 



AUTUMNAL FEVERS 



measure, without improving the condition of the 
patient, increases the tendency of the blood in- 
ternally, and exhausts further his little remaining 
strength. The existence then, of increased 
bilious secretions in our autumnal fevers, is 
rather a consequence, than a cause of the dis- 
ease ; and is sometimes (I may say frequently,) 
a consequence of the injudicious use of active 
purgative medicines. A sallow, or as it is usually 
considered, a bilious appearance in the eyes 
and skin, is usual in our fevers ; and has been 
called an evidence of their bilious character. 
This appearance should, however, be regarded 
merely as the effect of a disordered or impaired 
action in the superficial capillaries ; and it will 
be found to yield readily, sometimes in a very 
few hours, to the use of sinapisms. In persons, 
convalescent from fever, after the usual purging 
and mercurial treatment, the skin is commonly 
yellowish, and frequently deeply jaundiced.* I 
have never remarked this, in such persons, treated 
according to the mode hereafter to be pointed out. 

The free use of drastic purgatives and mercury 
impairs very much the digestive powers of the sto- 
mach; and the unhealthy appearance of the skin of 
those treated with them, I have attributed to the 
influence of that debilitated condition of the di- 
gestive organs. There is no popular prejudice 



' Vide Richter's Observation? 



OF SAVANNAH. 



more extensive than that calomel injures the 
teeth by contact with them, instead of through its 
agency ttpon the digestive organs. Decayed teeth 
have been charged upon us as a national defect. 
I have met with but few persons with bad teeth, 
who, upon inquiry, have not admitted their ha- 
bitual use of calomel as a purgative. The va- 
rious 44 Bilious" and " Antibilious" pills, have 
calomel in them ; and to their extensive use, and 
especially those of Lee, may, I believe, very 
correctly be attributed much of the decay so fre- 
quently observed in teeth. No one, I presume, 
has ever recovered from our fevers and a deep 
salivation, whose digestion has not been very 
essentially, and for a long time impaired. And 
this is the chief cause of such frequent relapses 
and protracted recoveries from them. The in- 
fluence of climate upon the skin, and the rela- 
tion between climate, diet, and the skin, have 
attracted, I think, less attention than their im- 
portance authorizes. Whilst the diet of the 
native inhabitants of equatorial regions is light, 
delicate, and spicy, and consequently of easy 
digestion, that of those dwelling in high latitudes 
is strong, highly stimulating, and of tedious di- 
gestion. As we recede from the equator, we 
find a more and more invigorating and stimulant 
food used. The fish oil so palatable and nou- 
rishing to the Greenlanders, would be as dis- 
gusting to the palate and offensive to the di- 



62 



AUTUMNAL FEVERS 



gestion of the native West Indian, as his spicy 
slops would be insipid to the former. The 
sailors of the Russian fleet s^nt a few vears 
since to Spain, vo bed he public lamps ■> Cadiz 
of their oil, and used it for food.* The more cold 
and bleak the region, the more stimulating are 
the food and drink of its inhabitants. The hotter 
the climate, the lighter and more easy of di- 
gestion is the food, and the more cooling are 
the drinks. Either character of food is the re- 
sult of necessity. That of cold regions protects 
the system against the severities of its climate, 
whilst that of the equatorial regions obviates the 
influence of their oppressive and long-continued 
heats. The natives of hot climates, where yel- 
low fever is endemial, are in a great measure 
exempt from this disease. Its subjects are 
chiefly strangers from colder and more healthful 
latitudes. The first influence exercised by a 
change of climate is upon the skin. 

The skin of a person unaccustomed to the 
heat of the West Indies, for instance, has its 
action soon reduced upon exposure below that 
of the natives ; upon the same principle, that 
the inhabitants of a hot climate suffer less from 
cold for a time, after being transported to a 
northern winter than the native of it does ; be- 

* Thomas Young, Esquire, of this place, informed me that some years 
sinee, whilst he was in Edinburgh, some Russian sailors were detected in 
robbing the public lamps of Leith, and eating the oil. 



OF SAVANNAH. 



63 



cause that which debilitates, and that which sti- 
mulates, produce greater effects upon those un- 
accustomed to their influence. The capacity 
with which nature has endowed our systems, 
gradually to adapt themselves to new situations, 
protects those habituated to hot climates and 
unhealthy situations irom the evils of such ex- 
posures. He who is habitually subjected to the 
causes of yellow fever, becomes eventually ex- 
empted from their influence. Hence, the im- 
punity with which the natives and old inhabitants 
of the West Indies are exposed daily to the 
causes of yellow fever, cholera, &c. In the 
southern Atlantic cities of the United States, a 
similar exemption is in a considerable degree 
extended to their permanent inhabitants ; be- 
cause, the cold of their winters is not sufficiently 
severe, wholly to destroy the influence of their 
autumnal atmosphere upon their systems. Hence, 
the inhabitants ot the northern and middle states 
are always obnoxious to the influence of the 
causes of yellow fever, when they exist in them. 

One reason alleged, especially in Europe, for 
a belief in contagion of yellow fever is, the re- 
puted fact, that the same person cannot take the 
disease a second time. Although, the unfre- 
quency of a second attack from the causes al- 
leged above, gives some plausibility to the as- 
sertion, it is certainly erroneous. It is a very 
common impression among our inhabitants, that 



4i4 



AUTUMNAL FEVERS 



a person who has experienced a severe fever 
should seek the following season a northern cli- 
mate for the perfect restoration of his health. 
Such as adopt this means, destroy the future 
protection derived from the attack of fever ; and 
render themselves upon another summer's resi- 
dence among us, almost as obnoxious to the 
causes of the disease, as upon the first exposure. 
Near three hundred negroes were brought into 
this place early in 1820, who had been captured 
on our coast, by government vessels. They were 
recently from Africa. These persons remained 
in Savannah during the prevalence of yellow 
fever, and not one suffered from the disease. 
Their exemption is attributable to their habitual 
exposure in their native country to the causes 
of yellow fever ;-equally concentrated with those, 
which prevailed here ; at that time, producing 
among us a mortality, perhaps unexampled in 
this country. Africans, however, like other 
people, are subject to the influence of climate, 
custom, and habits ; and, the exemption from 
yellow fever, which they acquire by their ha- 
bitual exposure at home, is gradually impaired 
by their translation to more healthy climates. 
Dr. Rush, supported by some West India phy- 
sicians, then in Philadelphia, declared the ne- 
groes not liable to yellow fever. Observation, 
however, soon satisfied him, of his error, which 
was readily acknowledged. The opinion of the 



OF SAVANNAH. 



65 



West India physicians, confined to the field of 
their observations at home, was no doubt cor- 
rect. It was the change of climate, with the 
subsequent change of habit, that subjected the 
negroes of Philadelphia to yellow fever. Ne- 
groes, habituated to the atmosphere of rice 
plantations, are in a very great degree exempt 
from severe autumnal diseases ; and the native 
African, more so than his offspring ; and, they 
are more liable to the diseases of winter. 
House servants are more liable to the former, 
and less so to the latter. This difference of pre- 
disposition, among members of the same family, 
is mainly attributable to the influence of their 
habits and customs. Many of our domestics 
became victims to the yellow fever of 1820. 
The rice field negro is less removed in his at- 
mosphere, habits, and customs, from those of his 
native country, than the house servant. The 
first delights in the heat of our hottest days, if 
we may judge from the manner in which he vo- 
luntarily exposes himself both awake and asleep 
to the direct influence of the sun ; whilst the 
latter studiously avoids it. In the proportion 
that an individual acquires an exemption from 
yellow fever, his liability to winter disease in- 
creases. Nature has most happily endowed our 
systems with a capacity to adapt themselves to 
new situations. That state of the system which 
is best qualified to shield us from yellow fever, 

I 



66 



iV i. l M S .\ J . SEVERS 



is least calculated to protect us from winter dish 
ease ; and vice versa. The skin of the African 
defending him from disease, in the midst of his 
exposures at home, upon a translation to a cold 
region, renders him highly obnoxious to winter 
disease. The vigorous health of the New Eng- 
1 and man that sustains him in his hardy exposure 
at home, qualifies him for severe disease, when 
translated to the West Indies. Each may in 
time, if he survives the first shock, become ha- 
bituated to the evils of his new situation ; but, 
can never enjoy the impunity of the native. 

How are these facts to be explained ? What 
agency so probable, so obvious, so simple, so 
certain, as that of the skin, the shield of the sys- 
tem, and the medium of external impressions? 
The admission of the agency of the skin in our 
protection from, and our subjection to disease, 
will certainly considerably relieve us from many 
existing embarrassments to the explanation of 
the modifications of our autumnal fevers, which 
are daily felt. 

The first impression to the sensations of the 
subjects of the cause of autumnal fever (be its na- 
ture and manner of application whatever it may) 
Is perceived in the skin. The second is a vitia- 
tion of the taste. This sometimes, and especially 
in mild cases, exists for several days. If the 
indication be now regarded, the disease may br 



Otf SAVANNAH. 



67 



prevented. Afterward follow pains* in the head, 
loins, and deep-seated bones, nausea, occasional 
gripings, sense of lassitude, thirst, &c. The 
appetite, which before had been impaired, be- 
comes not unusually, very keen, just before the 
supervention of the disease. This is attributable 
to the accumulation of blood in the capillaries of 
the alimentary canal ; in consequence of which, 
there is probably an increased secretion of gas- 
tric juice. This increased desire for food is 
frequently in a ratio, with the severity of the im- 
pending attack. Certain it is, however, that it 
more constantly precedes severe than mild cases 
of fever. Upon the supervention of the chill, 
as already remarked, the surface is inelastic and 
shrunk, the skin on the hands and feet becomes 
wrinkled, and palpable pits, especially in the 
extremities, follow the pressure of the fingers 
upon the skin, which loses its carnation appear- 
ance, and becomes more or less coloured with 
the venous blood, which would seem to loiter in 
the capillaries. Pains are felt in the deep-seated 
bones, from the undue determination of blood to 
them, as remarked by Rush. The respiration 
is oppressed with frequent sighings ; from a 
similar cause a sense of fulness is felt in the 
abdomen. As the chill advances, nausea is in- 
duced ; frequently followed by vomitings or 

; - gtahl remarked that congestions cfivc rise to pafn^. fiprtngel vol 



68 



AUTUMNAL FEVERS 



retchings, which usher in the hot stage ; which 
may be considered as the result of a reaction in 
the internal capillaries, to relieve themselves 
from the accumulation of blood upon them. 
This struggle between the two antagonizing 
systems of capillaries is made through the circu- 
lating vessels, and produces the disordered ac- 
tion observable in the pulse. Sometimes, from 
want of power in the internal capillaries, the 
reaction is not adequate to the restoration of 
heat to the surface ; and then, the disease 
in many cases speedily terminates fatally. In 
these cases, upon examination post mortem, 
great accumulations of blood internally are ob- 
served. Here, there is great restlessness and 
great complaint of internal heat. Such subjects 
after death, decompose very rapidly, owing to 
the accumulation of heat attendant upon the 
blood, internally At other times, the external 
capillaries yield more rapidly, and the paroxysm 
terminates in perspiration. In some instances, 
the external capillaries yield so far to the reac- 
tion, as to become the passive conductors of the 
serous part of the blood, which then passes off 
profusely through the pores. This perspiration 
is profuse and clammy, and always unfavourable. 
In almost every case of fever, that terminates 
unfavourably, there is this character of perspira- 
tion at some stage. Here the surface is cool, if 
not cold ; and the evaporation of the perspira 



OF SAVANNAH. 



69 



lion subtracts further from the heat of the sys- 
tem, already below the healthy standard. Oc- 
casionally, there appears to be a fixed resistance 
in the external capillaries, and a protracted re- 
action in the internal. In such, the skin is con- 
stantly hard, dry, rough, and very usually yel- 
low, with occasional petechial. The adnata of 
the eye is yellowish and watery, with its internal 
vessels deeply injected with blood. The re- 
missions are imperfect, and frequently in the 
course of the disease disappear. The stomach 
is usually but little affected with nausea. The 
bowels are disposed to costiveness ; the urine is 
straw coloured. There is occasional slight de- 
lirium. The sleep is disturbed. The fever be- 
comes chronic. The pulse is quick and fre- 
quent, with some degree ot hardness. The 
teeth are covered with a dark sordes. The pa- 
tient's flesh gradually wastes away. The pulsa- 
tions in the abdominal aorta are observed 
through the covering of the patient, who is now 
very peevish and irritable. His appetite and 
thirst become pretu constant, and he dies at the 
termination of from fifteen to thirty days, usually 
comatose, and in a state o( extreme emaciation. 
Previous to his death, there is a great disposition 
in the skin to the product of sores, upon 
which thick scabs form. I have never had an 
opportunity of examination after death, from 
such fevers ; but I nave but little doubt, that the 



AUTUMNAL 



morbid appearances are substantially the same., 
as in other cases of death from our fevers.* 

I should have remarked before, that occasion- 
ally there is a suppression of the urine in some 
cases ; in others, a mixture of blood and urine ; 
and occasionally, with very little or no urine, 
there are frequent discharges of almost pure 
blood from the bladder. The suppression of 
urine I have supposed attributable to a condi- 
tion of the kidneys, similar to that of the liver, 
when in fevers there is a suppression of bilious 
secretion ; namely, an engorgement of blood, 
overpowering the capillaries. Sometimes this 
engorgement is partially relieved by the dis- 
charge of blood, with or without urine, following 
a passive condition of the capillaries. Under a 
similar condition, and when there is a suppression 
of bilious secretion, there is frequently a dis- 
charge of heavy matter, assuming more or less 
the character of gross, bilious, or earthy pow- 
der, and bearing some resemblance to sand. In 
such cases, the kidneys seem to perform par- 
tially, the secretory function of the liver. This 
excretion of gross bilious and earthy matter has 
been confined within my observation to the latter 

* Upon seeing this remark in MS. Dr. Screven informed me, that he 
had examined the body of a patient, who exhibited the above train of 
symptoms, and that the post mortem appeatances were similar to tho?r 
which are seen in persons who have died under the ordinary curcinn- 
stances of autumnal fever. 



.SAVANNAH. 



7i 



stages of the fever, and the first of convales- 
cence ; and may be deemed, rather the effect of 
great debility of the kidneys, produced by their 
previous engorgement, than an indication of 
active disease. 

There is occasionally an enlargement of the 
parotid glands attendant upon fever : I have 
never known recovery to follow such enlarge- 
ment ; and where it has taken place within my 
observation, delirium and a long-continued coma 
have preceded death. This enlargement of the 
parotid gland, has frequently been mistaken, 
and attributed to a mercurial influence ; thence, 
exciting deceptive hopes in the practitioner, 
who mistakes its cause. 

Physicians have not so frequently made men- 
tion of this symptom, since the general introduc- 
tion of mercury in the treatment of yellow fever. 

I am indebted to Dr. Chalmers 9 valuable book 5 
entitled "jin Account of the Weather and Diseases 
of South Carolina? published about fifty years 
ago, for many remarks, corroborative in a con- 
siderable measure, of my opinions of the nature 
of our fevers, as already expressed. I succeed- 
ed in obtaining a copy of this rare and valuable 
work from London, in the winter of 1821 and '22. 
I regret that my exertions to obtain another trea- 
tise by this author, published previously, on the 
fevers of Charleston, have proved unsuccessfuL 
From the mass of valuable matter embodied in 



n 



AUTUMNAL FEVERS 



a small compass, in the work I have, I cannot 
but believe I should derive much instruction 
from the other ; and also have been made ac- 
quainted more fully, with his opinions of the 
nature of our autumnal fevers. 

Great diversity of opinion exists, as to the 
manner in which black vomit is produced. From 
my own observation, I cannot believe it to be 
either vitiated bile, or arterial blood. The only 
conclusion to which 1 have satisfactorily arrived, 
is, that the nature and manner of its production, 
are yet to be explained. After a free discharge 
of black vomit, there is less tension and distress 
over the liver, and in the abdomen generally, 
and a singular tranquillity of system and mind. 
The matter of the black vomit is discharged with 
as much ease, and in a manner very similar to 
that by which a dispeptic, or a woman far ad- 
vanced in pregnancy, spits up offending matter 
from the stomach. 

It is very certain that a matter is frequently 
discharged at stool, essentiall) the same with the 
matter of black vomit. The matter of black vo- 
mit has been supposed to proceed from the liver 
direct, or gall bladder. The contents of the lat- 
ter, are certainly peculiar, and approach nearer 
to the consistence and appearance of tar, than 
any thing else ; though there is present, a slight 
yellow cast, which is most observable, when a 
small portion is rubbed upon a glass. Dr. Sere 



OF SAVANNAH. 



73 



ven has seen this matter in the stool of a patient 
ill of fever ; — he recovered. 

It has been suggested, that the yellow fever is 
confined to salt water situations. The medical 
history of this city, New-Orleans, Natches, and 
other places, fully disproves this. There is as 
little correctness in the remark, that this disease 
appears only in cities. 

Some of as rapid and malignant cases of au- 
tumnal fever, as I have ever known, have ap- 
peared in the coldest weather of our winters : 
su i, within my observation, have been confined 
to feeble and delicate women. The occurrence 
of cold weather, during the progress of a case 
of yellow fever, usually renders it more pro- 
tracted and irregular, and endues it with an in - 
flammatory disposition. 

Repelled eruptions aggravate fever ; upon 
the reproduction of which, there is an evident 
improvement in the patient. I have known an 
ervthema of the skin, connected with gastric 
derangement, suspend autumnal fever for seve- 
ral days, upon the removal of which, the fever 
has recurred. 

In remarking upon the supposed loss of bal- 
ance in the blood, as caused by our fevers, let 
me not be understood as attributing an agency 
to the blood itself in their production. That, I 
have considered as a passive agent under the 
control and distinction of the vascular, and espp 

K 



74 



AUTUMNAL FEVER 8 



cialiy the capillary system. is in the disorder- 
ed condition, and irregular and morbid action of 
the vascular system, that I suppose fever to exist. 
Perhaps 1 have spoken of the effect, when I 
should have confined my elf to the cause : my 
object has certainly been perspicuity ; how far I 
have succeeded I know not. I certainly would 
not place myself among those who attribute 
the presence or absence of disease, to the condi- 
tion of the fluids, any more than I would exclude 
them from a due and proportionate importance to 
the system. Whilst the schools continue to be 
divided, between the Solidists and the Humor- 
alists, the practical physician will continue to 
know, that the fluids and the solids compose but 
an unit ; and that each is equally essential to the 
other. 

I cannot deny myself the pleasure of tran- 
scribing from the Thesis of my late pupil, Dr. 
Paul H. Wilkins, upon yellow fever, the follow- 
ing very ingenious remarks. I regret that his 
diffidence prevented the publication of it ; for it 
is among the few productions of that class which 
should be known and remembered. 

" Pathology reveals to us three sets of vessels 
morbidly affected in fever, viz. the arteries, the 
veins, and the capillaries. Of these, the two first 
are mutually dependent ; the last, have some- 
what of an independent action ; they are alL 



OF SAVANNAH. 



75 



however, governed by the same laws, and in- 
fluenced by the same causes ; but in different 
degrees, according to their power of action, or 
the irritability with which they are endowed. 
We therefore find that though all are affected, 
they still suffer in different degrees. As an in- 
stance, let us take the cold stage of intermittent 
fever : here we find the capillaries completely 
inactive, the veins sluggish, and the arteries less 
affected than all ; just in the same manner is it, 
in the disease of which I am treating. Assign- 
ing miasmata as the cause of this derangement, 
let us investigate its effects. If we view its first 
impression on the system, from the simple inter- 
mittent to this most aggravated form of fever, 
we will find that it exerts such a powerfully se- 
dative influence as to produce a paralysis (if I 
may so term it) of the blood vessels ; robbing 
them of their power of action, and suffering that 
state of congestion to ensue which exists in this 
disease. All the symptoms indicate this. What 
causes that languor and debility which usher in 
this disease? What causes that sluggishness 
and inactivity in the capillaries, and the conse- 
quent cold and relaxed skin, which are so re- 
markable? What causes that particular state of 
the stomach, which post mortem examinations 
reveal? The answer to all these is plain. ' Ven- 
triculo languido, omnia languent.' The concen- 
trated powers of miasmata invading the system 



76 



AUTUMNAL FEVERS, &C. 



in its most sensible part, by nervous influence, 
paralyze the blood vessels. The vis medicatrix 
natures of Cullen, or some inexplicable cause, 
endeavours to arouse the system by exciting 
vascular action ; but stunned as it were, by the 
violent attack, only one set of the vessels (the 
arteries) recover their action, and these only in 
a degree. The veins and capillaries, therefore, 
become receptacles for blood ; and that state of 
engorgement ensues, which I have noticed ; and 
which, according to the laws of the animal eco- 
nomy, attacks those parts with the greatest 
force where the cause first acted. A loss of 
balance is therefore produced in vascular action, 
the system sinks under the depression, and the 
whole train of symptoms ensue." 



IS AUTUMNAL FEVER INFLAMMATORY f 



If the preceding observations are not wholly 
without foundation, it is evident that our au- 
tumnal fevers have not an inflammatory charac- 
ter, and that, in truth, they are diseases of debi- 
litated action. The loss of the system by the 
almost constant and free perspirations, during 
hot weather, is certainly calculated to induce 
debility. During that season, there is usually 
a thinning of the body, a sense of debility and 
lassitude, and a sluggishness of motion. There 
is also great difficulty in producing inflammations ; 
hence the tendency to tetanus. The tongue 
of a fever patient is tremulous and unsteady, 
when thrust through the lips ; it is also thick- 
ened and shortened. Sometimes the tenderness 
produced by pressure over the stomach, the 
soreness upon the patient's turning himself in 
bed, &c. do not supervene until after the heat, 
&c. have subsided below the grade of health. 

In all inflammatory diseases, the heat of no 
part of the system is below the healthy grade : 
and frequently, in every portion, it is above it. 



78 



AUTUMNAL FEVERS 



Pain, it is believed, is always an attendant upon 
inflammation. Relapses rarely follow diseases 
of inflammation, except from very obvious im- 
proprieties- Clammy cold profuse perspirations, 
are not attendant upon inflammatory diseases, 
though they frequently accompany their unfa- 
vourable consequences, when there is an obvi- 
ous debility of system ; as in the existence of 
large abscesses, or mortifications ; and as the 
system overcomes these embarrassments, such 
perspirations subside. 

Passive hemorrhages from the gums, fauces, 
nose, &c. do not attend diseases of inflammatory 
character. Convalescence from diseases of in- 
flammatory character, terminating without organ- 
ic injury, is not protracted. Extreme debility 
and loss of strength are not attendants upon all 
the stages of inflammatory diseases If these 
positions be correct, the inference is plain, that 
our fevers are not of an inflammatory cha- 
racter. Opposed, as 1 am, upon this point, by 
an overwhelming majority of medical gentlemen, 
it is proper that I should examine the grounds 
upon which they lound their judgment. Lay- 
ing aside speculative points, the inflammatory 
character of autumnal fever, is inferred from 
1st, The indications of the pulse and blood ; 2d, 
The success of the depleting system ; and 3d. 
Post mortem appearances. 

Since the fatal experiments of 1820, no phv- 



OF SAVANNAH. 



79 



sician of this place would have the temerity to 
bleed in our fevers.* 

The evanescent reputed indications of vigour, 
by the pulse, which obtain chiefly in the strong 
and robust, unused to our climate, in whom this 
disease soonest runs into a state ot coilapse, and 
is therefore an unfavourable attendant upon fe- 
ver, are more than counterbalanced by other 
and less equivocal symptoms. 

It has been frequently urged, that our fevers 
are at first inflammatory, but that they soon run 
to a state of debility, and that bleeding is to be 
limited to the first stage. It need only be re- 
plied to this paradox, that as the stage of debility 
is the only one attended by danger, the influ- 
ence of which is chiefly to be resisted, it cannot 
be judicious to precipitate that condition, by re- 
ducing the tone of the system, and adding to the 
consequent debility. It is by such a doctrine 
only, that physicians can appear to reconcile the 
discordant character of their principles ; and 

* De la Roche and Gregory draw a distinction between the rapidity 
and intensity of the vital action. The first increasing in proportion to 
the reduction of the second. The one is excited by stimulants, and the 
other by tonics. In the consideration of our autumnal fevers the import- 
ance of this distinction has been much overlooked. The pulse of a pa- 
tient in one of them, is neither full, firm, nor frequent. It has no one 
characteristic of inflammatory action. It is frequently soft and inelastic, 
always yielding under pressure. The pulsations frequently seem to run 
into each other, from the feebleness of contractile power in the vessels. 
The pulsations of the different parts of the body are not in accordance. 
Vide Sprengel, vol- 5. 



so 



AUTUMNAL FEVERS 



certainly the theory and the practice wonderful- 
ly sustain each other. The classification of the 
pulse by Dr. Rush, certainly has not added to 
our knowledge of it. That he was as well ac- 
quainted with it, as any physician of his or any 
other age, I have no doubt ; but he certainly was 
not successful, in conveying by language, the 
impressions communicated to his sense of touch. 
It has been remarked, that blood drawn from 
persons under autumnal fever, exhibits evidence 
of inflammatory character. I have never seen 
such. No one will deny, that blood drawn from 
a patient does frequently, according to our im- 
perfect notions on the subject, indicate a condi- 
tion of the system, very different from what 
other and more satisfactory manifestations, 
would authorize us to admit. In some obvious- 
ly atonic conditions of the system, blood drawn 
is considered to indicate a state of active in- 
flammation. Frequently, the appearances, of 
the blood, do not admonish us of the extent of 
the inflammatory action present in the system, 
from whence it had been drawn. Whatever 
may be the real character of the blood let, from 
a few cases of fever, it is certain, that in a vast 
majority, it is very far from giving evidence of 
inflammation. The physician, who, disregarding 
other circumstances, relies upon the manifesta- 
tions of the pulse, or the condition of the blood, 
to indicate the remedies in the treatment of our 



/ 



OF SAVANNAH. 



Si 



fevers, will have reason for regret, and leisure 
for repentance. 

In regard to the second ground, — -The success 
of the depleting system, urged in proof of the 
inflammatory character of our fevers, — it need 
only to be remarked, that it will be difficult to 
find an experienced physician in the southern 
states, with so little regard to his own reputa- 
tion, as to claim any thing like success, in the 
treatment of severe cases of fever, by the de- 
pleting system ; and it is to be lamented, that 
whilst they are journalizing their own errors, and 
detailing the fallacies of their own doctrines, 
some of them should not have been impressed 
with some charity for the practice and views of 
others, not in accordance with their own. All 
the physicians, whose doctrines I am now ex- 
amining, feel themselves authorized to (and do) 
administer, the most potent stimulants, after the 
collapse or prostration of a patient, labouring 
under autumnal fever. Can this be compatible 
with their views ? If stimulants are proper in 
the prostration, for the purpose of reinstating the 
powers of the system, may they not be proper 
to prevent their overthrow ? Can it be seriously 
contended, that at one time, a disease is posi- 
tively inflammatory requiring depleting medi- 
cines, and that in one hour alter, it is one of ex- 
treme debility, requiring the strongest excitants? 
Such is the dilemma in which physicians daily 

T- 



82 



AUTUMNAL FEVERS 



place themselves. With the present physicians, 
must terminate the doctrine of inflammation in 
our autumnal fevers. The success of the treat- 
ment which it inculcates, cannot recommend it to 
their successors, who will have but few scholastic 
prejudices in its favour, and their whole observa- 
tion against it . It could not have been perpetuated 
to this day, but for the amalgamation of the mer- 
curial with the depleting systems of treatment. 
Of the former, I shall speak more fully here- 
after ; and shall barely remark now, that since 
the introduction of the sulphate of quinine, mer- 
cury seems to have lost much of its reputed spe- 
cific virtue in our fevers. But above all, the 
appearances after death, from yellow fever, have 
been triumphantly cited, as unequivocal and un- 
deniable evidence, of the inflammatory character 
of that disease. 

To me, these have afforded the most positive 
assurances, not merely of the absence of inflam- 
mation, but of the existence of a condition of the 
system, the very reverse of inflammatory. In 
what consist these appearances 1 Accumula- 
tions of blood in the brain, lungs, liver, spleen, 
and kidneys, and in the capillary veins of the 
villous coat of the alimentary canal, and espe- 
cially of the stomach ; in the capillary veins of 
the mucous membranes of the bronchia, and its 
ramifications ; in the bladder, pelvis of the kid- 
neys, Sqc. Upon engorgements of the liver, 



OF SAVANNAH. 



spleen, &c. I have already sufficiently remark- 
ed. It is to the appearances of the villous coat 
of the alimentary canal, that the advocates for an 
inflammatory condition of our fevers, have espe- 
cially called attention. Numerous, and minute 
examinations, have fully convinced me, that the 
appearances in the bronchia and its ramifications, 
bladder, and pelvis of the kidneys, are precisely of 
the same character with those of the alimentary 
canal ; and the observations which I make on the 
latter, must be considered as applying equally 
to all the mucous surfaces. For, if one be the 
seat of inflammation in our fevers, most assuredly 
all are. These appearances, be their nature what 
they may, are common to all our autumnal fevers, 
so far as we can depend, for testimony, upon such 
as terminate fatally. It is, however, certain, that 
they are much more extensive, where the disease 
is most violent and terminates most speedily. 

Upon opening the stomach of a person, recent- 
ly dead of autumnal fever, the internal surface 
presents a dull red appearance in one or more 
points. Upon exposure, for a short time, this 
dull red becomes more florid, and undergoes a 
similar change with that produced by exposing 
venous blood to the atmosphere. My atten- 
tion was first called to this fact, and its inference, 
by Dr Jas. P. Screven, of this place ; to whose 
intelligence and judgment, I have been repeat- 
edly indebted for valuable suggestions, and pr^ 



84 



AUTUMNAL FEVERS 



found opinions, whilst in the prosecution of these 
inquiries. Examined more attentively, this red 
appearance is found to be the effect of numerous 
points of red, distinct and wholly independent 
of each other, thickly grouped together. This 
is more obvious, where the villous coat is de- 
tached from the others, and held between the 
eye and the sun. In other parts of the stomach, 
these points of red are frequently found sparely 
spread. The small veins running between the 
villous and adjoining coats are found filled with 
blood, and the capillaries into which they ramify in 
the villous coat, are found very partially injected 
with blood. To the naked eye, when the villous 
coat is detached, and interposed between this 
organ and the sun, it is obvious that these small 
red spots are produced by particles of red blood 
detained in minute capillary veins, which are dis- 
tinctly seen, and may be traced to the larger 
trunks, into which they enter. If a portion of 
the villous coat be separated from the nervous, 
with a knife, and rolled up, and further portions 
detached by winding it upon itself, and then 
spread out, the red appearance which it had 
previously exhibited, will have disappeared, and 
small portions of the blood will be found on the 
side which had been next the nervous coat. 
The rolling of this coat upon itself, in the pro- 
cess of detaching it from the other, had pressed 
the blood from the capillary veins. This fact 



OF SAVAjNNAH. 



85 



suggested to me the idea of removing the red 
appearance by gentle and regular pressure of 
the finger; which was readily effected. Indeed, 
so easily are these specks destroyed, that care is 
necessary in detaching the villous coat, lest they 
be impaired or entirely obliterated; in which 
latter event, there will be no appearance of red 
remaining in the villous membrane. These ap- 
pearances, as before remarked, are always found 
in the stomach of those dead of our fevers ; 
frequently, in the intestines ; most commonly, 
the duodenum ; next, in the small, and occasion- 
ally, in the large intestines. They are also found 
in all the other mucous membranes. Dr. cre- 
ven's observation assures him, that the red ap- 
pearances in the bladder are most extensive 
in cases where bloody urine has been passed. 
I have never been able to discover them in 
any of the serous membranes. 

I have taken great pains in these examina- 
tions, to ascertain fully the condition of the capil- 
lary arteries ; and am fully satisfied, that they are 
constantly empty, and that the red appearance 
solely depends upon the blood in the capillary 
veins. In this, Dr. Screven fully concurs with me. 
The late Dr. Kollock, in whom were united in 
an eminent degree, the gentleman, the scholar, 
and the philanthropist, who had, from his ob- 
servations in 1820, been confirmed in his im- 
impressions of the inflammatory affections of the 



86 



AUTUMNAL FEVERS 



stomach in yellow fever, with a frankness almost 
peculiar to him, acknowledged his error, after 
examining with me, in 1822, several stomachs of 
persons dead from yellow fever. He informed 
me, that the appearances of the stomach, exhi- 
bited to him, were similar to those of 1820. 
This was corroborated by the observation of 
Dr. Dashiell, now of Cincinnati, who witnessed 
the examination of the stomachs of some sub- 
jects, who had died of yellow fever, in 1821. 
He perceived no difference between the post 
mortem appearances of such in 1820 and 1821. 
It was my misfortune to be deprived of oppor- 
tunities of examining subjects of yellow fever 
this year, by an early visitation of that disease 
upon myself. 

Much has been said by writers, of mortifica- 
tions, erosions, ulcerations, &c. of the stomach., 
in cases of yellow fie* er. I have searched for 
them most sedulously, but without success. I 
cannot readily believe, that under any circum- 
stances, these could occur during the life of a 
person ; for the violence which would produce 
either, would, I imagine, immediately extinguish 
vitality. I am by no means, disposed to assail 
the integrity of such as have reported these ap- 
pearances. They have been deceived in a man- 
ner very readily explained, and in all respects 
similar to their deceptions concerning the exist- 
ence oi inflammation in the stomach and intes- 



OF SAVANNAH. 



87 



tines, in the same disease. Moreover, it was but 
another step for a physician, who supposed he 
had seen the inflammation, to believe in the ex- 
istence of ulcerations and mortifications in the 
same parts. I have, in many instances, seen the 
appearances in the stomach and intestines 
which have been reported to be ulcerations and 
mortifications. The first, is a partially coagulated 
mucus, adhering: with considerable tenacity to 
the villous coal, exhibiting a rough and granu- 
lated surface. When this mucus is removed 
with a scalpel, the surface of the stomach under 
it is found entire. At other times, a portion of 
the surface of the stomach is quite black. This 
varies in size, from a small spot, to one several 
inches in circumference ; and may, by the eye, 
be readily mistaken for mortification. Upon ex- 
amination, however, this black colour will be 
found limited to the surface of the villous coat, 
and the extent which it embraces, will be found 
to be as firm, ami possess as much tenacity as any 
other part; and indeed, I have frequently, in en- 
deavouring to tear it, found other portions give 
away first. Occasionally, small black points, about 
the size ot a pin's point, are found seated in the vil- 
lous coat. These 1 have frequently picked out 
with a scalpel or probe's point ; they cannot be 
washed off. To what these black appearances are 
attributable, I know not ; but certainly, they do 



88 



AUTUMNAL FEVEHS 



not, in the slightest degree, partake of the na- 
ture of mortification. 

Then, the only authority for claiming the pre- 
sence of inflammation, in the alimentary canal 
of persons ill of yellow fever, is to be found 
in the existence of globules of blood in the 
extreme capillary veins of the villous coat, 
after death. As soon should the petechia of 
the skin in the same and other diseases, be refer- 
red to, to prove the existence of inflammation in 
that organ. They are both manifestly of the 
same nature, and both prove the existence of 
debility. If inflammation exists in the alimenta- 
ry canal of persons labouring under yellow fever, 
it is equally present in the bladder, kidneys, 
and the bronchia and its ramifications. The 
appearances (already described) in these vari- 
ous parts, depend upon the same causes with 
hemorrhages in fever ; from the fauces, mouth, 
nose, bladder, and other parts, namely, debility ; 
and it would be full as just to contend, that these 
are the result of inflammatory action. The red and 
fiery appearance of the eye, as frequently mani- 
fested in our fevers, has also been cited as evi- 
dence ol their inflammatory character. Removed, 
as the organ of vision is, (and for the wisest pur- 
poses) from the immediate influence ol the 
heart, it cannot be imagined that an inflammato- 
ry fever, would readil\ manifest itself there ; and 
it is a well established fact, that the eye does not 



OF SAVANNAH. 



Usually participate in the effects of such diseases. 
This appearance of the eye, I would attribute 
to the atonic condition of the capillary system,in 
our fevers. The circuitous course, by which the 
blood reaches this delicate organ, as well as the 
minuteness of its arteries, diminish very much 
the force with which its circulation is maintain- 
ed ; and consequently, render it most sensible 
to an impaired vascular action* Inflammation 
of this organ, for a similar reason* is with great 
difficulty overcome, by general depletion ; and 
when severe, local bleeding is frequently abso- 
lutely necessary, to the saving of vision. This 
red fiery appearance of the eye, as well as the 
yellow cast, which it occasionally assumes in our 
fevers, (both being dependent upon the same 
causes,) are speedily removed, by causing an in- 
flammation of the skin, by the application of si- 
napisms, and the free administration of tonics. 
I have, in a few instances, known death to su- 
pervene in thirty-six hours from the beginning 
of yellow fever, during the whole of which time, 
the heat of the system has been constantly be- 
low the standard of health. Is it possible that 
there could be inflammation in such cases ? 

In our fevers, the most plethoric sink soonest 
under evacuations. In inflammatory diseases 
they require usually most. 

If our autumnal fevers were inflammatory, 
detriment would be derived to the svstem, from 

M 



90 



AUTUMNAL FEVEKS 



any measures increasing its heat, and giving a 
continued type to them. From the practice 
pursued by me, (hereafter to be detailed) it will 
be seen, that constant success has attended the 
conversion of our remittent fevers into continued 
ones ; and the elevation of temperature subse- 
quent upon such conversion, 

To me, it has appeared, that the tendency of 
our fevers from their very first access, is to a 
state of collapse, not from indirect, but direct 
debility. If this tendency is resisted in the onset, 
we contend merely with the causes of debility in 
operation. If we wait until the collapse, and ac- 
celerate that by the use of evacuating medicines, 
we have afterwards to contend against these 
causes in their maturity, and with their effects 
greatly multiplied. That which is calculated 
to remove in conclusion, should certainly arrest 
an evil in its progress. This reasoning is not 
always applicable to chronic diseases, where 
there are frequently several distinct and some- 
times dissimilar stages. The post mortem ap- 
pearances heretofore detailed, I believe, are 
the production of the latter stages of the fever ; 
and probably, after the collapse. 

The petechia usually make their appearance 
when the action of the arterial system has been 
evidently reduced ; and but rarely appear on 
the neck, in the axilla?, groins, or between the 
thighs, where the arteries terminate more 



OF SAVANNAH. 



91 



speedily in the veins, and at shorter distances 
from their larger trunks. The terminations 
favourable or unfavourable, of our fevers, 
certainly bear little if any resemblance, to the 
terminations of inflammatory diseases. In fine, 
there is not one unequivocal evidence of inflam- 
mation, in any one stage of autumnal fever. It 
is a disease commencing in debility ; throughout 
its progress, displaying evidences the most posi- 
tive of debility, and terminating by the direct 
extinction of vitality. 

I have frequently been struck with a great 
similarity of general expression (if I may so 
speak) between persons in the advanced stages 
of yellow fever, and those who have suffered 
from lightning, without perishing. The resem- 
blance may be imaginary. 

For more than thirty years, the yellow fever 
has attracted more attention and called forth 
more remark, than probably almost any other 
disease ; and certainly, it is the only one in the 
treatment of which, some improvement has not 
been made within that time. The visions of the 
few, became the realities of many. The spe- 
culations of teachers are problems to their fol- 
lowers ; and one pretty conceit frequently over- 
turns the observations of a whole life. 

For thirty years has yellow fever been treated 
as an inflammatory disease, and now it is pro- 



AVTUiUXAL FEVERS 



Bounced incurable ! Those who fail, seem never 
to ask " is the disease inflammatory ?" 

Since writing the foregoing, I have received 
the May No. of the Philadelphia Journal of 
Medical and Physical Science, which contains 
an account of some dissections of persons who 
died of yellow fever in New-Orleans, in 1817- 
18-19, by my early friend and fellow-student, 
the late Br. Lawrence, of Philadelphia. To 
those who enjoyed his acquaintance, it is unne- 
cessary to remark, that he was not more dis- 
tinguished for unwearied diligence and dispas- 
sionate investigation, than for accuracy of ob- 
servation and strict integrity. 

Opposed as I am by his observations, I cannot 
but feel the full force which his opinions will have 
against me. Whilst we differ, as to the real nature 
of the affection of the stomach and intestines in 
yellow fever, I am gratified to find that the ob- 
servations of Dr. Lawrence confirm my own ex- 
perience as stated in the Philadelphia Journal for 
August, 1823 ; that the red appearance is con- 
fined to the villous coat of the alimentary canal : 
and I feel no hesitation in saying, that if he had 
examined that coat in the same manner with my- 
self, he would have, as must every one, come to 
the same conclusion that I have ; namely, that the 
red appearance of it arises from venous blood 
in the capillary veins, or, in other words, that it 
is congestion a?id not inflammation. 



OF SAVANNAH. 



m 



Dr. Lawrence is induced to infer, from one of 
his dissections, that the matter of black vomit 
is composed in part of the villous coat. I can 
have no doubt but the appearance which the 
villous coat exhibited in this instance, was the 
result of partial decomposition ; for the subject 
n which it was observed was examined the 
"next morning after his decease." I have al- 
ready spoken of the rapid decomposition which 
follows death from yellow fever ; and have at- 
tempted to explain the cause of it. And with a 
view to avoid confounding the effects of this 
early decomposition, with the appearances pro- 
duced by the fever, I have invariably made my 
examinations within a short period after death ; 
and frequently when the body was yet warm. 
Dr. Lawrence further confirms my observations, 
as to the existence of dark bluish or dark leaden 
coloured spots, occasionally in the stomach, 
which it is evident he does not consider as con^ 
nected with mortification. 



UPON SALIVATION IN AUTUMNAL FEVERS. 



The establishment of a fact connected with a 
controverted doctrine, is frequently in medicine, 
at least as difficult as the discovery of the truth 
of the theory itself : so subservient are our senses 
to our opinions. To this is attributable the differ- 
ence of opinion that still exists in relation to the 
curative power of mercury, in the treatment of 
our autumnal fevers. Whilst the American and 
British physicians claim for this medicine a con- 
trolling influence, those of the European continent 
as generally deny its virtue in these diseases. 
This diversity of opinion is attributable mainly, 
if not exclusively, to the difference which exists 
in the pathological views of the two parties con- 
cerning these fevers. Believing, as the American 
and British medical public generally do, that the 
hepatic system is mainly involved in the fevers 
of warm climates, it almost follows of course, 
that they should deem mercury a powerful agent 
in their cure. The physicians of the continent, 
who deny such an agency to the biliary system, 
cannot admit the reputed importance of the mer- 



FEVERS OF SAVANNAH. 



95 



eurial treatment. I have but little doubt, that the 
reputation of mercury in the treatment of our 
autumnal fevers fifty years hence, could be pre- 
dicted, if it could now be decided whether they 
would at that period be considered of a bilious 
character ; for I cannot believe, that the success 
which has attended the mercurial treatment 
would ever have of itself maintained its repu- 
tation* 

Few, it is believed, will now claim with Rush, 
that salivation is serviceable in yellow fever, only 
from its evacuant effect. The more general 
explanation (independent of its supposed action 
upon the liver) of its modus operandi, is founded 
upon a remark of the celebrated J. Hunter, that 
no two actions can exist at the same time in the 
same system, and that the lesser will yield to the 
greater. In this, as in many other cases, refer- 
ence is made to a known fact, to establish and 
illustrate a doubtful hypothesis. That mercury, 
when given as an alterative, frequently increases 
the excitement of the system, there can be no 
doubt ; but it is equally true, that as soon as it 
seizes fully upon the salivary glands, it produces 
a local excitement and a general debility of the 
system. There are few local affections, that 
produce greater constitutional debility, than a 
profuse salivation. It is, however, yet more 
erroneous to suppose, that the mercurial action 
is superior to, or can control, the febrile. It is 



96 



AUTUMNAL FEVERS 



remarked by Rush (and who has not witnessed 
the same ?) that salivations which exist during 
the intermissions of a fever, are sometimes 
wholly suppressed by the paroxysm. If fever 
has the power to suppress mercurial action, it 
certainly has the power of preventing it. I 
have witnessed a few cases, where a salivation 
supervening in the early stage of a fever, has, 
without in any way mitigating the disease, or 
shortening its duration, run on with it for many 
days much to the distress of the patient and an- 
noyance of the physician. I have further known 
fever to supervene in persons labouring under 
salivation, produced in the treatment of chronic 
diseases, where the ptyalism had subsided upon 
the supervention of fever, and returned upon its 
termination without the intermediate administra- 
tion of a single grain of mercury ; as the follow- 
ing case will show. 

A man who had passed a considerable por- 
tion of the preceding eighteen months in the 
hospital, with an extensive ulcer of the groin, 
was admitted in the fall of 1822, with the same 
affection. It had been treated as syphilitic, and 
he had been several times salivated. Awash of 
lime water and calomel was directed by me> 
which in a very short time produced a profuse 
salivation. In a few days after, he was attacked 
with remittent fever, upon the supervention of 
which the symptoms of salivation wholly dis- 



OF SAVANNAH. 



97 



appeared. The fever terminated in nine or ten 
days, upon which the salivation returned in its 
full force with mercurial foetor, swelled salivarv 
glands and tongue, inflamed gums, and furred 
tongue. Not one grain of mercury was admi- 
nistered to this patient after the supervention of 
fever ; nor was there, at that time, another case 
of salivation in any of the wards. In most in- 
stances, however, the system, whilst under the 
influence of fever, refuses to take on a mercu- 
rial action. Nothing is more common than for 
salivation to succeed a fever, where mercury has 
been administered in its progress. There should 
be as little surprise felt at the superinduction of 
mercurial action upon the termination of fever, 
as there is at the refusal of the system to take 
on that action during the existence of a fever, 
that paralyzes its functions, and impairs its sus- 
ceptibilities. Occasionally, salivation does pre- 
cede the termination of fever, although its seve- 
rity has been previously much mitigated. The 
presence of salivation here, however, is certainly 
an evil superadded to the disease ; for, the su- 
pervention of the former has been the conse- 
quence of the mildness or improvement of the 
latter, and is wholly unnecessary to the cure. 
The advocates for the controlling influence of 
mercury in autumnal fevers, claim that where 
salivation follows the declension or termination 
of such disease, that declension or termination, 
N 



93 



AUTUMNAL FEVERS 



was the effect of what they please to term (how 
intelligibly others may decide) " the silent in- 
fluence of mercury upon the system." The 
silent influence of this medicine is, I believe, 
however, more fully recorded in our bills of 
mortality, than any where else. One of the five 
apothecaries in this place, in 1820, informed me, 
that he retailed to the physicians of the city, 
during that season, about thirty pounds of calo- 
mel. Where mercurial action is superinduced 
upon a fever, which in my observation is of rare 
occurrence, it certainly adds to the debility of 
the system ; and neither prevents nor mitigates, 
but I am satisfied, frequently gives a direct ten- 
dency to other unfavourable symptoms. I have 
several times known prostration to follow, which 
I believed was produced by salivation : and, I 
believe, I have in some instances, prevented 
such prostration, by a speedy suppression of 
salivation, with the free use of ice applied lo- 
cally, both upon the face and in the mouth. 
This practice I know has been much repro- 
bated. Although it has occasionally not suc- 
ceeded with me, I have never known any injury 
result from this treatment ; and though the 
action of mercury upon the system, may be pe- 
culiar, I believe that action is suspended as soon 
as salivation is fully induced ; and the affection 
becomes local, and should be treated as such 



OF SAVANNAH. 



99 



When prostration follows salivation, the mer- 
curial affection subsides suddenly; evidently 
from the want of vascular action to support it ; 
and as the action of the system returns, so does 
the salivation. 1 believe, that in all cases, the 
mercurial fetor increased salivary secretion* 
swelling of the parotid and submaxillary glands 
and tongue : — in fine, all the symptoms of a pro- 
fuse salivation where they exist, wholly subside 
several hours before death. This, I certainly 
have frequently witnessed; and have never 
known an exception, since my attention has 
been called to it. This remark is designed to 
embrace other diseases, treated with mercury 
producing salivation, as well as fever. 

It is much more usual, however, for salivation 
to follow a day or two after the termination of 
fever ; which I deem rather a new evil, arising 
to obscure a favourable issue of the disease, than 
any thing else. I have very frequently known 
salivations to occur in this manner, four or five 
days after the abandonment of mercury in de 
spair ; when the patient has been allowed to 
float along under the efforts of nature, the phy- 
sician silently awaiting a result which it was ac- 
knowledged he could not control. Such was 
my own case in 1820. For five days after the 
abandonment of mercury by my attentive and 
kind physicians, and the second after the termi- 
nation of my fever, a violent salivation super- 



100 



AUTUMNAL FEVERS 



vened ; the annoyance of which, no one can un- 
derstand, who has not experienced it. Such sali- 
vations increase very much the atonic condition 
of the digestive organs. 

The loss of his saliva, cannot be atoned for to 
the convalescent. Salivation certainly protracts 
very much recovery from our fevers ; for it is 
very rare, that a person who has suffered seri- 
ously, and has been subjected to the mercurial 
treatment, should he be so fortunate as to sur- 
vive both the disease and the remedy, is re- 
stored to any thing like tolerable health before 
the ensuing summer. The tedious recovery is, 
I know, attributed to frequent relapses, which 
I would impute to the atonic condition of the 
system, and especially of the digestive organs 
and liver; and to the debilitating effects of 
the salivation. Certainly, other patients, who 
have been so fortunate as to escape the hor- 
rors of ptyalism, have usually (other circum- 
stances being equal) convalesced much more 
rapidly. 

Occasionally, without any previous indications 
of its approach, coma suddenly seizes upon per- 
sons in deep salivation. In such, within my ob- 
servation, death has invariably followed ; and I 
have been strongly induced to suspect, that the 
salivation was the chief, if not sole agent, in pro- 
ducing the coma. 

The late Dr. Cutter, who fell a victim to our 



OF SAVANNAH. 



101 



fever in 1820, informed me a short time previous 
to his death, that he witnessed the presence 
of salivation and black vomit in the same pa- 
tient, at the same time, that season ; and that 
the former preceded the latter, by more than 
thirty-six hours. The patient died. 

There is, perhaps, no medicine which has 
been used so vaguely, and inconsiderately, as 
mercury, by well-educated physicians. It is 
given indiscriminately, in all affections of the 
liver, in the acute and chronic inflam prions, 
and in enlargements of this organ : — In the sup- 
pression of bilious secretion, as well as where 
there is a redundancy of it. Nor is the em- 
pirical administration of this medicine confined 
to affections of the hepatic system ; in all of 
which, it is well nigh considered a specific It 
is the last resource of the modern physician ; 
and wherever he finds other medicines unavailing, 
he seeks relief in a salivation In diseases of 
debility, he gives mercury, as a stimulant : — in 
those of imagined excitement, he gives it to 
produce a new action. 

1 have already alluded to the great quantities 
of mercury, which were administered in the 
fever of 1820, in this place. Although, it is 
believed no physician claimed to have saved 
a single individual from death, that season, by 
the production of salivation, it was administered 
the following season with equal freedom, and 



102 



AUTUMNAL FEVERS, &C. 



apparent confidence by most of them in the 
same disease. I am gratified, however, to say, 
that since 1822, the mercurial treatment has 
gradually yielded to my own ; which latter, 
although still condemned, has been to a consi- 
derable extent, adopted generally. Sinapisms, 
Bark, and Serpentaria, which, in 1821, were 
treated with little deference, are now daily in 
the hands of all our physicians, when treating 
autumnal fevers. And whilst my fellow-beings 
are daily rescued from death by their agency, I 
am content to be denounced by some of those 
who have learned their value from me. He is 
indeed unacquainted with human nature, who 
expects to receive justice at the hands of those 
whose worst passions he has excited by success- 
fully combating with and exposing their invete- 
rate errors. 



METHOD OF TREATMENT. 



Previously to detailing the treatment that 
I have adopted, in our autumnal fevers, it is 
proper that I should submit some remarks upon 
the remedies on which I rely. 

1st. Sinapisms. These have heretofore been 
used for their rubefacient virtue. I have re- 
sorted to them, to inflame the skin. Used as 
rubefacients, they are certainly in some mea- 
sure revulsive ; here, their influence is usually 
as evanescent as the discoloration which they 
produce. Where the skin is inflamed, and 
that inflammation continued, the revulsive or 
derivative power of the sinapism is permanent, 
and consequently perpetuates the good which 
it at first achieved. Heretofore, the sinapism 
has been chiefly resorted to in moments of 
emergency, for a temporary benefit. Hereafter, 
it will be considered as one of the most efficient 
means of arresting and controlling autumnal 
fevers ; at least, such it has been in my hands. 
I refer the reader to No. 12 of Professor Chap 
man's Journal (August, 1823.) for a statement 



104 



AUTUMNAL FEVERS 



of what I deem the advantages which rube/a- 
dents {sinapisms) possess over vesicatories in 
the treatment of yellow fever. 

Ordinarily, the plaster is prepared by me, by 
making the mustard into a paste, by the addition 
of hot water. Dr. Screven prefers cold water, 
which I have rarely used. Vinegar reduces the 
strength of the mustard, and flour impairs it. 
When it is desirable to give additional power to 
the sinapism, spirit terebinth, is substituted for 
water. The former preparation answers fully, 
save when there is great torpor in the skin, with 
or without profuse cold perspirations. 

The first effect of the application of a si- 
napism, is rubefacient, merely ; if longer con- 
tinued, the skin is inflamed. This inflamma- 
tion, I am now disposed to believe, does not 
extend beyond the retimucosum ; which is 
chiefly constituted of a minute network of in- 
numerable blood vessels and nerves, which, 
passing through the areolae of the cutis vera, 
are expanded upon it. This vascular network 
composes the capillary system of the surface.* 

* Je crois qu'on doit entendre par corps reticulaire, un lacis de vais- 
seaux extremement fins, et dont Ies troncs deja tres delies, apres avoir 
passe par les pores multiplies dont le corion est perc£, viennent se rami- 
fier a sa surface, et contiennent differentes especes de fluides. L'exist- 
ence de ce reseau vasculaire est mis hors de doute par les injections fines 
qui changeant entierement la couleur de la peau au dehors, sans 1'alterer 
beaucoup au dedans. C'est lui qui, comme je l'ai fait observer, est le 
siege principal des irruptions multiplies dont la pluspart sont reellement 
jtraiigerea au corion cvtmw. Bichat, Anatomie General, torn. ii. p. 665 



OF SAVANNAH. 



105 



The inflammation thus produced, continues 
for an indefinite period ; and may be perpe 
tuated from time to time, by the reapplication 
of the sinapism, as exigencies should require. 
Where the fever terminates (as it frequently 
does,) gradually, and imperceptibly, and without 
any critical discharge, the inflammation as gra- 
dually subsides, and the old cuticle gives place 
to a new one. When, however, the fever ter- 
minates by a copious perspiration, although the 
inflammation may have existed for a week or 
more previously, it occasionally is resolved b}- 
the discharge of serum ; forming vesicles similar 
to those produced by a blister. Sometimes,these 
vesicles are formed in a few hours after the re- 
moval of the sinapism, and during the conti- 
nuance of the fever. This, I have found to be 
an unfavourable circumstance ; 'and when it oc- 
curs, I am usually disappointed in the favourable 
influence upon the patient, which I had expected 
to derive from their inflaming the skin ; because, 
I am defeated in my design, and this ready sepa- 
ration of the cuticle is itself evidence of great 
vital debility. In such instances, their operation 
and influence are similar to that of the blister ; 
an inflammation which is revulsive in its influ- 
ence, is produced in the skin; which is speedily 
resolved, by the effusion of serum forming the 
vesicle. The capillaries of the surface, which 

would have been invigorated by the continuance 

0 



iQ6 



AUTUMNAL FEVERS 



of the inflammation, now have their imperfect 
action further impaired, by the atonic condition 
of those which have been immediately debilitated 
by the vesication. Blisters are revulsive, so long 
as they inflame the surface. In proportion to 
the exhaustion of the energies of the system, is 
this tendency to vesication from sinapisms. Dr. 
Screven observes, that where bleeding has been 
resorted to in fever, sinapisms are very apt 
to produce blisters. There is a similar ten- 
dency in persons habituated to free potations. 
Where the system does not react under the in- 
flammation of the surface, vesications habitually 
precede dissolution. 

Occasionally, where prostration has succeed- 
ed to the abrasion of the cuticle, following the 
application of sinapisms, or the formation of vesi- 
cles, consequent upon that application, a suffi- 
cient action takes place in the skin, and pus is se- 
creted. This, I have always found a favoura- 
ble circumstance ; the new action appearing to 
fulfil the same end, in regard to the revulsion, 
and equalizing the circulation, which are deriva- 
ble from the simple inflammation of the skin, 
without discharge. The sinapisms are habitu- 
ally applied at the same time, to the abdomen, 
fore arms, and legs ; and are made to occupy as 
much of the surfaces of these parts, as is conve- 
nient. The period which is required for them 
to inflame the skin, varies in each case. Or 



OF SAVANNAH. 



10? 



casionally, thirty minutes is sufficient ; at 
times, almost as many hours are required. When 
there is much dryness and heat in the skin, it 
becomes necessary to moisten the sinapism 
from time to time, or apply fresh ones. When 
applied during the exacerbation of fever, or 
when the heat of the surface is above the healthy 
grade (and occasionally, at other times) so soon 
as they fully produce iuflammation upon the skin, 
there follow almost invariably, free evacuations 
from either the bowels, kidneys, or skin, and al- 
ways to the decided advantage of the patient. 
In such cases, the volume of the blood is so 
much reduced, by the amount of the evacuations, 
as to relieve the internal capillaries of much of 
their burthen ; by which, they are enabled to act 
more vigorously in restoring an equalized circu- 
lation. It is not necessary that the sinapisms 
should be kept on, until the skin is fully inflamed; 
unless in cases of prostration ; for so soon as the 
inflammation is raised to a certain point, it will 
continue on and perpetuate itself. This point, 
which cannot be defined, will soon be ascertain- 
ed with considerable accuracy, by an attentive 
physician. If the sinapism be removed too 
early, which will be known by the imperfection 
or recession of the discoloration, it should 
be immediately reapplied ; for, if delayed, it 
will afterwards become more difficult to produce 
inflammation on the same part. In cases of 



108 



AUTUMNAL FEVLilS 



prostration, and where there is much exhausta* 
lion of the system, or great debility, and ten- 
dency to cold perspirations, it is difficult, and 
indeed frequently impossible, to produce at first, 
a complete and full inflammation of the skin. In 
such cases, some respite from the sinapisms 
should be allowed to the patie nt, as soon as it is 
found, that some permanent discoloration of the 
skin is produced. Having obtained this footing 
upon the circulation, the sinapisms should be re- 
applied at intervals of six or twelve hours ; when 
they will be submitted to with less reluctance by 
the sick; and the impression made upon the sys- 
tem by the medicines, will aid in perfecting the 
inflammation. In these cases, the reapplication 
of the sinapism, is frequently suggested to the 
patient, by a recurrence of some distressing sen- 
sations ; from which they had before relieved 
him ; as retchings, shortened respiration, great 
internal heat, &c. By the repeated application 
of the sinapism to the same part, the inflamma- 
tion will be in a few days rendered complete ; 
by which time, frequently, the patient is relieved 
from all danger, and nothing more is required, 
than the continuance of the medicines for a short 
time, with proper nourishment; as hereafter 
suggested. In cases of several days standing, 
and where there is much torpor in the skin, con- 
nected with a dry condition of it, upon the re- 
moval of the first sinapism, it will be remarked, 
that there is usually some elevation of the skin : 



OF SAVANNAH. 



109 



which elevated portion has a yellowish cast, 
which is not removed, until the skin by succeed- 
ing applications of the sinapisms is fully in- 
flamed ; and even then, there is not that florid 
red which obtains in other inflamed surfaces. 
Around this elevated portion, and obviously con- 
nected with it, is sometimes remarked a narrow 
band of red, evidently arising from the sinapism i 
but which had not been covered by it. 

The severe pain, and sense of burning, which 
add much to the revulsive power of the sina- 
pism, remain some hours after its removal, 
and until inflammation has become full. In this, 
I have supposed, that the sinapism is preferable 
to nitric acid, or any other caustic application ; 
which acts more speedily than the former. In 
one instance, I have known a patient reapply 
the plaster, to relieve himself from this sense of 
burning. He assured me from repeated expe- 
rience, that this measure mitigated the pain. 
Was this the effect of the mechanical influence 
of the plasters upon the delicate capillary ves- 
sels ? The use of a sinapism is frequently fol- 
lowed by a very keen appetite for food. 

In addition to inflaming the skin of the abdo- 
men, legs, and fore arms, it sometimes becomes 
necessary in the course of the treatment, to ap- 
ply the sinapisms to the hypochondria, thighs, 
and arms. If there be much tendency to deli- 
rium, a decided advantage is frequently derived 



110 



AUTUMNAL FEVERS 



from the application of a sinapism to the back of 
the neck, and between the shoulders. Here, I 
have sometimes found a blister more servicea- 
ble than the sinapism, for a reason that will be 
readily understood. 

It is obvious, that the great advantages deriva- 
ble from the use of sinapisms, are attributable to 
their revulsive power ; which equalizes the cir- 
culation, and aids the other means, in maintaining 
an equal distribution of blood. Hence, the com- 
parative tranquillity of the blood vessels ; the 
composure and the refreshing sleep, which fre- 
quently follow their application ; hence, the re- 
lief from the distressing sensations of inward 
heat, the removal of pains in the head, loins, and 
bones ; — the removal of thirst, and dry parched 
appearance of the tongue ;— the removal of ten- 
derness over the stomach and liver, of sense 
of fulness in the abdomen, of red fiery eyes, 
of immobility of the pupils,* of occasional deaf- 
ness, of delirium; and hence, the relief from 
a distressing anxiety of the stomach, heretofore 
so appalling a symptom in our fevers ; and hence. 

* I have recently, in several cases of children ill of fever, attended with 
convulsions, remarked, that when asleep, upon my raising the eyelid, the 
pupil is found very much contracted, and yields very little to the influence 
of light ; upon waking in such, the pupil became very much dilated, and 
would not contract upon excluding the light by closing the eyelid. I 
have several times, upon the same patient, observed this. In one instance 
of a child roused from a deep sleep, I observed that as he fell asleep, and 
before the complete closing of the eyelids, the pupils suddenly fell from a 
widely dilated condition into one of almost complete contraction. 



OF SAVANNAH. 



Ill 



finally, the restoration of the natural sensations 
of the patient, together with the due exercise of 
the functions of the body. 

The application of the sinapism to the abdo- 
men, certainly exercises a much greater influ- 
ence over the system, than when made to any 
other part. In the early stage of fever, it fre- 
quently subdues it at once. Dr. Screven has 
observed, that a sinapism applied to the loins, 
will fail to relieve pain in that part, when one 
placed over the stomach, will readily remove it. 
The application of a sinapism to the whole ab- 
domen, made upon the supervention of the first, 
or even second paroxysm of fever, frequently 
arrests and removes the disease, as it also re- 
moves the precursors of fever. Critical evacua- 
tions frequently succeed to the successful appli- 
cations of sinapisms, previous to prostration. 
Inflaming the skin with sinapisms, prevents the 
recurrence of chill or ague. Hence, their great 
importance in the treatment of obstinate inter- 
mittents. I have not in the last five years, had 
a single incurable case of this disease. The sys- 
tem once subjected to the influence of the in- 
flamed surfaces, this is to be perpetuated by the 
reapplication of the sinapisms from time to time, 
to them, until they maintain a deep red appear- 
ance ; after which, if sinapisms be again required, 
they should be placed on new surfaces ; for, the 
inflammations already produced, have attained 



112 



AUTUMNAL FEVERS 



their highest point, and consequently exercise 
already their greatest revulsive power. 

When the inflamed surfaces assume a dark 
purple colour, an appearance as of venous blood, 
it is unfavourable. 

Whether the pulse be full, rapid, irregular, 
and frequent ; or thin, feeble, and quick, the in- 
flammation of the skin by sinapisms, improves 
its character, and approximates it more nearly 
to a healthy condition. Whether the heat of 
the system, generally, be above or below the 
grade of health, the successful application of si- 
napisms, restores it much more nearly to its or- 
dinary standard. Whether the skin be hot, 
harsh, and dry; or cold, shrivelled, and bedew- 
ed with clammy perspirations, the inflammations 
produced by sinapisms, very much improve its 
condition. 

By their use, patients are frequently relieved 
from extreme prostrations, when the system can 
be influenced by no other remedy, with which 
we are acquainted. Here, the influence is more 
prompt and certain, if the patient has not been 
purged previously to the collapse. 

The inflammations produced by sinapisms in- 
crease during the exacerbations of fever; and 
appear in that way to shorten, mitigate, or con- 
trol them. 

The yellow cast in the skin and eyes, so fre- 
quently, though erroneously considered as the 



OF SAVANNAH. 



113 



effect of bilious matter absorbed into the circu- 
lation, is usually removed by the application of 
sinapisms. I am induced to think, that this ap- 
pearance in the early stages of our fevers, differs 
essentially from that which supervenes in pro- 
tracted cases, and after the disappearance of 
fevers, treated after the mercurial fashion. 
The latter, I have no doubt, is the effect of a 
disordered condition of the digestive organs and 
liver. The former depends upon the condition 
of the capillary system. 

To a physician unaccustomed to the influence 
of sinapisms, in the treatment of our autumnal 
fevers, the remark will appear almost incredible, 
that they frequently in a few hours relieve a pa- 
tient from the most distressing restlessness ; and 
whilst yet on him produce sound and refreshing 
sleep : such is nevertheless the fact. 

The application of the sinapism, at all times 
painful to the patient, is especially so in the last 
stage of prostration. I have seen persons, from 
whose wrists the pulsations had for some time 
subsided, suffer the most acute agony from them; 
and greater, I have supposed, than at any other 
period of the disease. In such the skin is 
not inflamed nor even discoloured. Patients 
are frequently induced to make applications 
of oil, cream, or cold water, to the inflamed sur- 
faces, after the removal of the sinapism, to miti- 
gate the pain and burning. This measurably de* 

5 



114 



AUTtPSJ&AL FEVERS 



feats the design in their use, and should con- 
stantly be prohibited. It also frequently renders 
the reapplication of the sinapism necessary at 
a future time ; when probably otherwise a re- 
currence to it would not have been necessary. 
Such applications sometimes produce vesications. 

In the treatment of the fevers of children, sina- 
pisms are frequently of great value, and espe- 
cially when in the progress of the disease there 
is a tendency to collapse. Applied in the earlier 
stages, their influence is not so decided ; nor is 
there any thing singular in the appearance of 
the inflamed surface. Applied, however, when 
there is an obvious tendency to prostration, 
but before it has actually supervened, sina- 
pisms certainly achieve frequently, what can 
never be derived from vesicatories. In the 
skin, upon which they are at this stage applied, 
they frequently produce a red appearance, 
similar to that found upon minute examinations 
in the stomach of a person who has died 
of autumnal fever, as heretofore described. 
Following this, the limbs upon which they had 
been applied, swell, and present somewhat the 
appearance of oedema. Around the plastered 
portion, a yellowish cast is presented in a circle, 
some five lines in breadth, which is hot to the 
feel of the attendant, and exceedingly painful to 
the patient. At the same time, the whole of the 
plastered surface is becoming more and more 



OF SAVANiNAH. 



116 



painful. This yellowish band encircling the 
plastered surface continues hot and painful from 
three to six days ; when, upon an obvious im- 
provement in the condition of the patient, the 
inflammation is resolved by a copious secretion 
of yellow serum. About this time, the cuticle 
becomes detached from the whole plastered 
surface, and with that extending to the sur- 
rounding recently inflamed portion, forms a 
common vesicle by a discharge of serum from 
the lately inflamed border; on the depending 
portion of which vesicle, the yellow serum rests. 
After this first, there is no following secretions 
of serum ; for I have suffered this vesicle to 
remain undisturbed, four or five days, during 
which there was no augmentation in its bulk. 
Sometimes a superficial ulceration, not extend- 
ing below the rele mucostem, takes place ; at 
other times, the red points are only removed by 
sloughing ; but frequently, a new cuticle is re- 
produced without loss of substance. These red 
spots, originally seen in the plastered portion, 
remain, and are seen through the new cuticle for 
some time, and until the vigour of the system is 
greatly restored. When the rete mucostem does 
slough, the cuticle forms over it, leaving a slight 
depression, differing in appearance essentially, 
from a common cicatrix, upon which a cataplasm 
will not afterwards act. This cuticle is disposed 
to be lax and loose upon the skin; and the ariolee 



116 AUTUMNAL FEVERS 

in the cutis vera beneath, are distinctly seen 
through it. The oedema which arises soon after 
the application of the sinapism, usually subsides 
in two or three days ; always before the solution 
of the inflammation. In these cases, I have 
supposed the inflammatory action in the band 
encircling the plastered portion, to be highly 
revulsive in its influence upon the system. 

It should be added, that at this period of the 
disease in children, I give freely bark, ser- 
pentaria, and Cayenne pepper ; and I have no 
doubt, but that mortification would follow such 
a condition of the skin produced by sinapisms^ 
under a different system of treatment. 

2d. Capsicum Jlnnuum. I am as much at loss 
for a phrase* by which to mark the character of 
this medicine, as I am unable to find a proper 
class for it. It is so essentially different from 
every other article of the materia medica, as to be 
entitled to a place by itself. It certainly par- 
takes of some of the qualities of both a stimulant 
and atonic ; and yet, its prominent virtue differs 
from both. Its action upon the system is cer- 
tainly as peculiar, as it is frequently important. 
To a system suffering under the debilitating 
influence of autumnal fever, the Cayenne pepper 
imparts an energy, a warmth, and a tone entirely 
peculiar to itself, without ever producing aia 



* Or. Scwven calls it an aromatic tonic. It is that, and it is mor<v 



013 SAVANNAH. 



117 



undue or injurious excitement ; if that may be 
so called, which approximates the debilitated 
and overpowered energies of the system nearer 
to a state of health, though still below it. Its 
pungency on the palate has certainly given 
to Cayenne pepper a character for harshness, 
wholly unmerited ; and daily disproved in its 
extensive application to culinary purposes, and 
table use. In no part of my practice have I 
found so much difficulty in overcoming the pre- 
judices of patients. I use this article in the form 
of infusion; say a table-spoonful of the powdered 
Cayenne to a pint of boiling water ; of which, 
from a table-spoonful to a wine-glassful may be 
given every hour, (or in extremis, oftener,) ac- 
cording to circumstances. Patients frequently 
express the comfortable feelings, which this 
article produces upon the stomach ; and espe- 
cially, where great gastric distress had existed. 

In his Therapuetics Professor Chapman ob- 
serves, that Cayenne pepper has been used in 
the treatment of intermittents and yellow fevers. 
I have somewhere seen, in a general order 
from a surgeon-general to the British forces in 
the West Indies, directions to the surgeons 
*o use this article in the cure of yellow fever. 
4 understand, that Cayenne pepper was some 
years since used in Charleston in the form of 
pills, in the treatment of the same disease. 
Dr. Anthony, of Augusta, informs me, that he 



118 



AUTUMNAL FEVERS 



has used this article with very decided advan- 
tage. Next to sinapisms, (in conjunction with 
which it is frequently directed) Cayenne pepper 
exercises the most powerful influence in calming 
the irritated stomach ; and in cases of extreme 
torpor of the skin, where all applications to it 
are inefficient, its power is yet, in this particular, 
unimpaired. 

I have repeatedly known it to suppress black 
vomit, and in one instance of recovery after the 
presence of this symptom, (the only one I have 
ever witnessed) I attributed the cure to this 
medicine. It occurred in the case of a Mrs. 
Nickerson, in 1820. 

Cayenne pepper comes admirably in aid 
of sinapisms, in equalizing the circulation and 
heat, and preparing the system for the adminis- 
tration of the serpentaria, or bark, or both. 
It is equally important, in removing the cold 
stage of adynamic fevers, and in sustaining the 
system, against the recurrence of the paroxysm. 
It gives elasticity and moisture to the hot, harsh, 
dry skin ; and has a powerful influence in check- 
ing profuse cold, and clammy perspirations. It 
comes admirably in aid of sinapisms, in relieving 
determinations to the brain, as indicated by 
headach and dilated pupils. It has a decided 
tendency to remove the dry rough condition of 
the tongue. 



SAVANNAH. 



119 



This article, certainly exercises a very extra- 
ordinary and peculiar power upon the capillary 
vessels. In its action, it is essentially revulsive. 
By invigorating the capillary action, it sharpens 
the sensibilities of the system. 

Dr. Parker, long an eminent physician of this 
place, informs me, that his preceptor, the singu- 
lar and eccentric Dr. Beacroft, for a time, used 
a combination of Cayenne pepper and bark in 
the treatment of our autumnal fevers. If he had 
associated the use of sinapisms with it, in the 
manner heretofore suggested, I feel satisfied he 
would never have abandoned the combination. 

3d. Serpentaria Virginiana. This medi- 
cine had long been in extensive use in the treat- 
ment of autumnal fevers : though of late years, 
it has been very much neglected. Dr. Chal- 
mers speaks in the highest terms of it. In com- 
mon with other tonic remedies, it has been 
thrown aside by the mercurialists, as inadmissi- 
ble in the treatment of our fevers. 

Of all the articles used by me, in the treat- 
ment of our fevers, this requires most caution in 
its administration. Used without the aid of si- 
napisms, it frequently increases the disposition 
to delirium, and wherever that is present, it 
should be rejected. If given during the exist- 
ence of delirium, it is very apt to produce coma, 
and subsequently death. Before I had learned 
fully, the circumstances under which the ad- 



120 



AUTUMNAL E!EV$RS 



ministration of this medicine was injurious, I am 
now satisfied, that I occasionally produced bad 
effects by using it. I recollect, that during one 
season, (1821) in which I gave it, I found that 
wherever delirium followed its administration, 
the case terminated fatally ; unless upon the very 
first indication of that, the serpentaria was with- 
held and sinapisms extensively applied ; and to 
a favourable prognosis, I frequently attached the 
condition, that delirium should not occur. Since 
I have been in the habit of inflaming the skin 
more extensively by sinapisms, previous to the 
administration of other medicines, I feel no ap- 
prehensions of injurious effects following the use 
of serpentaria ; and in most cases, it certainly is 
a valuable auxiliary. In a few cases, among the 
poor, where, from the want of attendance, &c» 
the usual remedies could not be administered, I 
have confined patients to the use of this article 
alone, and with success. In this, however, it 
was administered in the first paroxysm of the 
fever ; most of the cases were double or simple 
tertians. The addition of the serpentaria to the 
Cayenne pepper tea, is valuable, where there is 
a harsh, dry, or hot skin. It is wholly inadmis- 
sible, in cases where there is present, cold 
clammy perspiration ; and in all cases, indeed, 
where there is a disposition to frequent per- 
spirations, from its tendency to produce them. 



OF SAVANNAH. 



121 



Independent of its other qualities, serpenta- 
ria is certainly a tonic of very considerable 
power; which is best availed of, by using it, 
when the infusion is cold. I ordinarily pre- 
pare it, by having a pint of boiling water in- 
fused in an ounce of the root ; of which, I give 
about a wine-glassful every hour or two. When 
conjoined with the Cayenne pepper tea, as it 
most ordinarily is, it is usually in the proportion 
of three parts of infus. serpta. to one or two of 
the pepper tea. 

4th. Bark. The qualities of this article are 
too well known to require much from me. In this 
country, it has for many years been rejected from 
the treatment of our autumnal fevers, save such 
as are strictly intermittent ; and even in these, it 
is by no means a popular remedy ; — most phy- 
sicians attributing to it a character offensive to 
the stomach, and a great tendency to produce 
visceral obstructions. As regards the first obiec- 
tion, there is certainly much justice in the re- 
mark, when bark is used in the ordinary way, 
and without the previous use of sinapisms to in- 
flame the skin. When, however, the surface has 
been extensively inflamed, the bark mixed in 
pepper tea or infus. serpenta., either separately or 
combined, maybe given in very large doses, with- 
out at all embarrassing the stomach. I frequently 
give in severe cases, as much as three and four 
ounces in twentv-four hours ; where the disease 



m 



ATjf ITMNAL FEVERS 



is mild, less than half that quantity. I use it m 
every stage of the fever, whether of remission 
or exacerbation, with equal convenience. Once 
commenced, it is continued throughout the dis- 
ease, in as large quantities as the stomach will 
receive ; and it is mainly to this mode, that I at- 
tribute the very general success, which has at- 
tended the use of it in my hands. 

The second objection which has been urged 
against its use, namely, that it produces visceral 
obstructions, will be noticed hereafter. 

To a wine-glassful of serpentaria infus. and 
pepper tea, I am in the habit of adding a table- 
spoonful of the bark in powder. This dose is 
repeated every hour or two according to circum- 
stances. If by the too frequent administration 
of the medicine, the stomach is overcharged, the 
excess is cast off, and after a little delay, the 
medicine is resumed without inconvenience ; 
when, after having given bark freely, for a day 
or more, it has been suddenly withheld, the other 
medicines being continued, the remittent or pa- 
roxysmal character of the fever which had been 
destroyed, recurs, but again yields to this me- 
. dieine. 

I have used the sulphate of quinine, and with 
complete success. I have thought that the re- 
coveries where that was used, were not as speedy 
as by the use of bark ; and that the reaction of 
the system was not so vigorous. Whether it be 



OF SAVANNAH. 



the result of habit, I will not pretend to decide ; 
but I do prefer the bark, and still habitually 
use it. 

I have been gratified to learn, that some of our 
physicians, who, in 1821, '22 and '23, pronounced 
bark a poison, when used in our fevers, in 1824 
declared that they could not dispense with 
sulph. quinine in their treatment. More re- 
cently, (1825,) some of our physicians complain 
that they are not so successful with the sulphate 
of quinine, as the last year. The explanation 
of this will be found in the fact, that the aid they 
received in their perplexities from this medi- 
cine, induced them to over estimate its virtues. 
I have recently in a few cases, administered the 
bitter extract, prepared from the residuum 
remaining after making sulphate of quinine, as 
introduced by Dr. Jackson, of Philadelphia, and 
with complete success. In all respects, so far 
as a limited observation will allow me to judge, 
it has appeared equal in efficacy to the sulphate 
of quinine. 

5th. The .Arsenical Solution. In mild cases 
of intermittent and remittent fevers, I have made 
much use of Fowler's arsenical solution, and 
certainly, with very decided success. This me- 
dicine, I am induced to think, acts chiefly here 
by its revulsive power. Where it is efficacious, 
in the treatment of these fevers, it is speedily 
so. It has long been enjoined, that it should 



not be given more than for eight or ten suc- 
cessive days. In the ordinary doses of ten drops, 
thrice a day, it is known that it fails frequently. 
In 1821, I attempted to improve its efficacy, by 
giving in a shorter time, the same quantity usually 
given in the ordinary period of eight or ten days ; 
by which, two hundred and forty to three hun- 
dred drops would be administered in four or 
five, instead of eight or ten days. With this 
view, I directed ten drops every four hours. By 
this mode, I found that the solution usually pro- 
duced after two or three doses, a gentle and 
regular moisture upon the skin ; and sometimes, 
a looseness of the bowels. Wherever the 
moisture was produced and maintained, the 
disease readily yielded ; and the medicine was 
soon after withheld. I soon adopted the plan 
of giving frequent doses, for some two or four 
hours before the expected recurrence of an in- 
termittent paroxysm, and suspending its admi- 
nistration the intermediate days. Used in this 
manner, it was full as effective as when given 
daily; and the system was measurably saved 
from the influence of a most active poison. 
Thus given, it usually produced a mild diapho- 
resis, of several hours continuance, and sup- 
pressed the return of the paroxysm. The pre- 
vention of two or three fits of fever in this man- 
ner, was usually sufficient to effect 3 perfect 
cure. 



UF SAVANNAH. 



m 



I once sent half an ounce of the arsenical 
solution to a sailor, labouring under a double 
tertian, who had previously taken no medicine. 
Ten drops were directed every four hours. 
Upon visiting him the next morning, although 
he was very sick the previous day, I found him 
eating heartily of some bread and cheese. Upon 
inquiry, I learned, that through mistake, the 
whole of the medicine had been given him at 
two doses ; which had produced an active purg- 
ing, and afterwards a very profuse perspiration 
of near twelve hours duration. No further me- 
dicine was directed, and in three days after, I 
saw him engaged at work, on board ship, in good 
health and spirits. He had no recurrence of 
fever during his stay. I have derived decided 
benefit from the use of Fowler's solution as well 
in remittent as intermittent fevers* 

In the treatment of our autumnal fevers, my 
attention is mainly directed to the fulfilment of 
two indications. The first is, to diffuse the cir- 
culation equally throughout the whole system. 
Upon the success of this, depends the relief 
from local plethora and congestion, causing 
pains in the back, bones, and head, delirium, ten- 
derness of the stomach upon pressure, nausea, 
vomitings, and incessant but unavailing retchings, 
sense of fulness in the abdomen, sensations of 
internal heat, restlessness, sighing, costiveness, 
dry, parched tongue, &c. &c. The second in- 



126 



AUTUMNAL FEVERS 



dication is, to give tone and energy to that dif- 
fused action of the vaseular system. By its 
fulfilment, the local affections above recited, are 
prevented from recurring ; tone is given to the 
capillary circulation, the energies of the system, 
impaired by the disease, are invigorated ; the 
debility upon which it subsists, is arrested ; and 
the fever disappears. The first indication is to 
be fulfilled, by inflaming the skin, extensively, 
with sinapisms. These are directed without 
regard to the temperature of the surface, or 
condition of the patient ; provided, fever be 
present at the time. When there is much cold- 
ness of the surface, obvious debility or prostra- 
tion present, the Cayenne pepper tea is always 
directed in aid of the sinapisms ; and some- 
times, (as when indicated by the habits, condition 
or constitution of the patient) where neither ex- 
ists to any considerable extent. As already 
remarked, the time required to inflame the 
skin varies greatly in different persons, and 
in different conditions of the patient. Where 
much irritability of the stomach is present, it is 
proper to withhold all drink until the sinapisms 
have produced a decided impression upon the 
system. Otherwise, the continued retchings 
which are apt to be produced by the introduc- 
tion of fluids into the stomach, counteract more 
or less the influence of the application upon the 
■system. When it shall have been ascertained, 



OF SAVANNAH. 



127 



that the sinapisms have been removed too soon, 
it becomes proper that they be immediately re- 
applied ; as, in serious cases of fever, no im- 
portant advantage can be derived to the patient, 
until the circulation is essentially equalized by 
inflaming the skin ; as the administration of the 
bark and serpentaria previously, frequently does 
injury, and they are apt moreover to be rejected 
It occasionally occurs, that the portion of the 
skin inflamed by the sinapisms, is elevated 
above the adjacent surfaces. This is habitually 
a favourable indication ; for it shows the capillary 
system to be in a condition to take on readily a 
vigorous action. This inequality of surface soon 
disappears, in consequence of the invigorated 
action in the inflamed portions extending itself 
beyond the seats of the inflammation. 

The second indication is to be fulfilled by the 
administration of the bark, serpentaria, and 
Cayenne pepper, in as large and frequent doses 
as the stomach will bear, and the condition of 
the patient demand. When the first indication 
is effected, the quantity is limited only, in severe 
cases, by the capacity of the stomach. It has 
already been remarked, that occasionally, as 
much as four ounces of powdered bark have 
been administered in twenty -four hours ; and that 
too, for successive days, to the great benefit of 
the patient. I know that the statement of this 
fact is calculated to excite doubt in the minds 



128 



AUTUMNAL FEVERS 



of many experienced physicians. It is not, 
however, on that account, the less my duty to 
make it. I appeal to the future experience of 
those who will dare to examine and judge for 
themselves. That this article is offensive to the 
stomach of a fever patient, subjected to the 
ordinary treatment, I well know ; as indeed are 
almost all other articles in ordinary use. But 
diffuse the excitement throughout the system ; 
relieve the abdominal viscera, of the excess of 
blood, which oppresses them ; impart tone to 
the alimentary canal, by the free use of Cayenne 
pepper tea ; and it will retain any quantity of 
bark, which its capacity will readily allow it to 
receive. The great virtues of the bark are 
chiefly to be derived, when that article is admi- 
nistered in large quantities, in a small space of 
time ; and then, it is highly serviceable, in the 
early and almost certain removal of fever. 
Occasionally, some oppression is felt from the 
volume of medicine. This is relieved by the 
reapplication of the sinapism, which, when op- 
pression of the stomach is present, should always 
be made. This sensation is most apt to be per- 
ceived upon the approach of a paroxysm, or 
exacerbation of fever, or in the early stage of 
either, at which time the reapplication of the 
sinapisms becomes proper to arrest the first, or 
to shorten and mitigate the second ; for, in no 
stage of fever, is the efficiency of this remedy 



OF SAVANNAH. 



more obvious than when applied early in an ex- 
acerbation of this disease. Unless it is evident 
that such exacerbation will be brief, and incon- 
siderable, I invariably direct it. It is sometimes 
delayed, until pain recurs in the head or back, 
or until some other symptom indicates its use. 
Then, such symptoms are almost as certainry 
removed, as they would have been prevented by 
the earlier resort to sinapisms. 

Earlier or later applied, in the exacerbations 
of fever, sinapisms not only relieve pain and 
local distress, but most commonly induce gentle 
moisture in a short time, and produce sleep or 
complete composure. As soon as it becomes 
evident that the disease is arrested, in its ten- 
dency to an unfavourable issue ; or, in other 
words, so soon as it becomes obvious, that the 
remedies exercise a controlling influence over 
the unfavourable symptoms, it is proper to add to 
the vigour of the system by nourishment, in the 
form of chicken water, beef tea, and porter, or 
claret wine. Their administration neither inter- 
feres with the medicines, nor requires a reduction 
in their quantities ; for, as the system reacts under 
the treatment, its capacities increase. Porter is 
preferable to claret ; but it occasionally occurs 
that flatulence is produced by the former, to such 
an extent, as to require its discontinuance. This 
symptom sometimes arises in the course of the 
disease, obviously without connexion with the 
administration of any article ; then, I have con 

R 



ISO 



AUTIMKAL FJBVERS 



sidered it as decidedly favourable. From one 
to two pints of either claret or porter ma) be 
advantageously given in twenty-four hours. A 
small portion of water is sometimes added to 
either, but not unless by the desire of the patient. 
The great object is to give such food as is most 
nutritious, and least irritating, in small quantities, 
frequently repeated. With this view, the juicy 
meats have been chosen ; which patients are 
allowed to chew, from time to time. By this 
course, there is little danger of overloading the 
stomach ; which, from the reigning debility, is 
readily done, either by the volume of food, or its 
irritating character. Most of the slops in ordi- 
nary use, and especially those of a farinaceous 
kind, may be advantageously dispensed with. 

It results from the above sketched mode of 
treatment, that relief is first wholly or in part, ob- 
tained from the local affections, as pains, nausea, 
oppression, retchings, &c; after wh ch, the 
excitement is equalized throughout the sys- 
tem, and then elevated above its healthy stand- 
ard ; in consequence of which, the pulse be- 
comes regular, full, and soft ; the respiration 
steady and natural ; the excretions somewhat 
increased, and approaching a healthy condition; 
Irequent moisture appears upon the surface, the 
tongue assumes or approaches a healthy condi- 
tion, the patient sleeps frequently and com- 
posedly, the appetite returns, there exists a 
gentle thirst ; the bowels are moved from time 



Oif SAVANNAH. 



to time, if they had been costive ; one or more 
motions follow the reapplication of the sina- 
pisms, and the mind of the patient is tranquil or 
buoyant with the anticipation of a speedy reco- 
very. After one or more days, according to the 
severity of the fever, or the period at which the 
treatment was commenced, the elevated excite- 
ment begins gradually to decline, and regardless 
of the regular administration of the medicines, 
and the occasional recurrence to the sinapisms, 
it gently and almost imperceptibly, subsides to 
its healthy pitch ; and the patient is left in a state 
of convalescence, which in the absence of posi- 
tive exposure, is short and complete. Occa- 
sional doses of the medicines are given, for seve- 
ral days after the termination of the fever. 

The creation by this mode of treatment, of a gen- 
eral and elevated excitement of the system, and 
its gradual declension to a natural stage, is to my 
mind, not only an unanswerable argument in fa- 
vour of the existence of debility in our fevers ; 
but, one of the most interesting facts connected 
with that treatment. The gradual declension of 
the elevated excitement, is certainly attributable 
to the due distribution of the blood, and conse- 
quently the perfect restoration of the functions 
of the various organs of the body, or (and what 
amounts to the same) the equal and perfect ac- 
tion of every part of the vascular system. That: 
the fever is overcome by this excitement, is to 
me obvious, for once created, it is extended be- 



m 



AUTUMNAL FEVERS 



yond the duration of the fever. In this we have 
a happy illustration of John Hunter's remark, 
that u no two (general) actions can exist at the 
same time, in the same system." That of the fe- 
ver, subsisting upon an unequal distribution of 
vascular action, being the weaker, yields to that 
created by my plan of treatment, whose tendency 
is to create and to maintain an equal circulation ; 
which, being the condition of health, is necessari- 
ly the most powerful, and subdues the action of 
disease ; or, in other words, the action of debility. 
Here, we have then, a new and more power- 
ful action ; whose tendency is to health, over- 
coming and subduing the disordered action of 
fever, whose course is to increased debility, and 
death. This is the action, which has been in 
this country, so universally, and as erroneously, 
claimed for mercury. 

Frequently, two or more paroxysms of fever 
have occurred; or several days have elapsed, 
since the supervention of the disease, before the 
attendance of the physician is required ; during 
which time, frequently, in addition to the mere 
effects of the disease, detriment has been derived 
from the injurious use of active evacuants, or some 
other improper medicine. Under every circum- 
stance, the first application should be sinapisms, 
as before remarked. If there exist much dispo- 
sition to vomit, or severe retchings, the Cayenne 
pepper tea should also be directed ; and as little 
diluted as may be, according to the emergency, 



OF SAVAJSJSAH. 



(Ordinarily, however, and where there is no great 
urgency, the patient is directed to abstain from 
all things else, until the sinapisms have perform- 
ed their office, when, according to the indications, 
the other medicines are to be administered. 

I have already alluded to the usual production 
of evacuations, by the surface, Jtidneys or bow 
els, by the first application of sinapisms. This 
is more common, and remarkable, where the pa- 
tient has been allowed to remain several days 
without treatment. Upon the succeeding appli- 
cation of the sinapisms, these evacuations are 
not ordinarily so copious. It is questionable, if, 
when at all serviceable, they ever fail to induce 
some evacuation. Their influence upon the 
bowels, is very remarkable. I am frequently 
urged by patients, who imagine they feel some 
uneasiness from the supposed want of a stool, to 
give a purge. My answer is, that upon the super- 
vention of the next paroxysm or exacerbation, 
the sinapisms will be used, when the bowels will 
be sufficiently moved ; and it is indeed rarely, 
that I am disappointed in my anticipations. 

The moderate evacuations caused by sina- 
pisms, when the system is oppressed, are cer- 
tainly salutary ; and aid, by reducing somewhat, 
the volume of blood; and, by leaving the blood 
vessels less embarrassed, in restoring an equal- 
ized circulation. Where the sinapisms are ap- 
plied to a skin in cold clammy perspirations, 
tone is imparted to it ; the perspirations are 



134 



AUTUMNAL FEVERS 



checked, and the bowels usually moved Pretty 
free purgings sometimes follow the application 
of the sinapisms; in all such, it will be found, 
that the evacuations are highly unwholesome 
and offensive ; and not thin and watery, as when 
caused by active purges. 

Where the skin is rough, dry, and hot, to 
the feel, when, although there may be occa- 
sional vomitings, there is not usually severe 
gastric distress, (for with the latter there is 
usually more >r less moisture of the surface' 
the pepper and serpentana are early adminis- 
tered, with sinapisms ; because, they have a 
powerful tendency to aid in the improvement of 
such condition of the surface. If, however, 
there should be severe pain in the head, deli- 
rium, or tendency thereto, the serpentaria 
should be withheld, and the pepper given alone. 
After the head has been relieved by the inflam- 
mation of the skin, the serpentaria may be safely 
and advantageously given. The infusion of this 
article, given cold, is by no means so apt either 
to affect the head, or promote perspirations, as 
when hot. It is equally improper to administer 
the serpentaria, when there is an undue ten- 
dency to moisture of the skin, or cold clammy, 
or profuse perspirations. When any or all of 
these exist, the Cayenne pepper is highly ser- 
viceable in aiding to arrest them. To this, the 
bark may be advantageously added, as soon as 
the skin has been fully inflamed, and the system 



OF SAVANNAH. 



135 



begins to react ; until which, its use is injudi- 
cious. I have frequently given bark previous to 
such reaction, but never with advantage. Given 
freely, during the apyrexia, where sinapisms 
have not been previously used, it frequently 
offends the stomach, and disgusts the patient ; 
where, however, it is retained, it almost cer- 
tainly embarrasses the stomach, upon the super- 
vention of the succeeding paroxysm. Where 
the skin has been extensively inflamed, bark, 
serpentaria, and Cayenne pepper may be safely 
and advantageously given, in every after-stage 
of the disease. 

The objection which has been made, that bark 
produces visceral obstructions in fevers, is with- 
out foundation, in cases where the skin is pro- 
perly inflamed previous to its administration. 
Then visceral obstructions are not only pre- 
vented, but old ones, both of the liver and 
spleen, are actually removed. To this tact, I 
have the additional evidence of Dr. Screven. 
But, so long as the irregular distribution of 
blood produced by autumnal fevers, is allowed 
to remain by omitting the use of sinapisms, so 
long will visceral engorgements during fever 
degenerate into visceral obstructions after it ; 
whether bark be used or not ; but more exten- 
sively in the first case, and, so long will the 
cures be incomplete, and the patients conse- 
quently subjected to relapses. It is certainly to 
be lamented, that objections, which have grown 



136 



AUTUMNAL FEVERS 



out of the injudicious use of this invaluable me- 
dicine, should have had so great an influence in 
banishing it from use, in a disease where, pro- 
perly administered, it is certainly unrivalled in 
efficacy. 

In the presence of prostration, with its usual 
attendant symptoms, reliance is to be mainh' 
placed upon the sinapisms and Cayenne pepper. 
Here, additional sinapisms should be applied to 
the thorax, hypochondria, arms, and thighs ; and 
the utmost energy and perseverance are neces- 
sary in the physician. The sinapisms should be 
removed from time to time ; and their efficacy 
will be certainly increased by the addition of 
spirits of turpentine. Frictions with red pepper, 
or mustard, are serviceable. A wine-glassful 
of the Cayenne pepper tea, may be given every 
fifteen or thirty minutes. The recovery of the 
patient wiii much depend upon the previous 
treatment, to which he had been subjected ; and 
also upon his previous habits of life. If he had 
been subjected to the evacuating and mercurial 
system of treatment, or if he had been exten- 
sively blistered, but faint hopes should be enter- 
tained of a recovery. Ordinarily, there is but 
little difficulty in producing a reaction atter pros- 
tration in a patient, not subjected to previous 
treatment. The energies of his system seem 
to be rather overcome than exhausted. His 
prostration has been purely the result of the 
fever, unaided by the administration of debili- 



OF SAVANNAH. 



137 



latiug medicines. With him prostration has been 
a stage in the course of the fever ; and not the 
achievement of an injudicious treatment preci- 
pitating an evil, by sapping the energies of the 
system. 

Free purgings in our fevers certainly increase 
the tendency of the blood to the abdominal vis- 
cera, and lessen the ability of the system, to 
equalize the circulation. In the fall of 1821, a 
schooner arrived in this port, after a short pas- 
sage from Havanna, with four of the crew ill of 
yellow fever. One was in articulo mortis; 
another of them had been sick four, and the 
other three days. The three latter were carried 
to the hospital ; and recovered under the use of 
sinapisms, pepper, and bark. They had taken no 
medicines previous to coming under my charge. 
They recovered more readily than other pa- 
tients of the same calling, almost daily admitted 
into the hospital, who did not exhibit the same 
violence of disease, but who had been some- 
times bled, and frequently, purged freely, be- 
fore admittance by physicians, who were not 
disposed to send them to the hospital, whilst 
there was a prospect of their recovery. I 
feel no doubt, but that if the three patients 
from Havanna had been freely purged, previous 
to their prostration, it would have been next to 
impossible to have raised them from the condi- 
tion in which they were when received into the 
hospital. 



138 



AUTUMNAL FEVERS 



Where prostration takes place in persons, 
habitually intemperate, little hope need be 
entertained of recoveiy ; for the system of such, 
accustomed to the influence of ardent spirits 
in health, are for the most part, insensible to 
the most powerful agents, when overturned 
by fever. Moreover, in such, the tendency to 
collapse, is wonderfully strengthened ; and 
prostration, if it is not present from the first, su- 
pervenes at a very early stage of the disease. 
Habit ial drunkards very rarely become the 
subjects of autumnal fevers ; unless, when they 
curtail, from any motive, their usual allowance 
of drink. I have rarely known an instance, 
where one has attempted a reformation in sum- 
mer or autumn, by suddenly refraining from 
strong drink, without taking fever. When, under 
such circumstances, fever has accrued, within my 
observation, it has constantly proved fatal ; and 
such cases always assume a malignant character, 
from their very commencement. The security, 
which the habitual drunkard enjoys, is very re- 
markable, and was fully manifested in 1820. 
During the greater part of that season, several 
persons habitually exposed themselves, night 
and day, to the w eather, in a state of constant 
intoxication. One of them died suddenly, from a 
stroke of the sun. He had not been long in this 
climate. None of them suffered from fever. 

In prostration, most physicians, regardless of 
their notions of the inflammatory nature of au- 



OF SAVANNAH, 



139 



turnnal fevers, resort to the free use of stimu- 
lants, and their selection of them is frequently 
highly injudicious. It is then, that abandoning 
suddenly their mercury, their purges, and their 
blisters, they overpower their patients with ar- 
dent spirits, wine, volatile alkali, &c. &c. 

My own observation assures me, that espe- 
cially in prostration, ardent spirit is highly in- 
jurious. It seems to impair the nervous power. 
Independently of the agitation which it produces 
in the vascular system, and its tendency to in- 
crease cold clammy perspirations, the torpor 
which very soon follows upon the excitement, 
when any is produced, certainly adds to the 
reigning debility, impairs the little remaining 
excitement of the system, and consequently 
interferes essentially with the success of other 
and more permanent impressions. These, how- 
ever, are not always the greatest evils, that re- 
sult from the administration of ardent spirit. In 
cases of prostration, it frequently fails to excite 
the system at all. Here, its sedative influence is 
directly exercised ; and it adds immediately to 
the debility of the system, without having pro- 
duced any intermediate excitement. This is not 
unusually its effect, and it has certainly not at- 
tracted that attention to which it is entitled. The 
same objections, in some degree, extend to wine. 
It is certainly not to be relied on in prostration. 
The presence of dysenteric symptoms in au- 
tumnal fevers, should not affect the treatment of 



140 



AUTUMNAL FEVER'S 



the latter. Bark, serpentaria, and Cayenne 
pepper, may be as safely and beneficially admi- 
nistered then, as at any other period of the 
fever. Indeed, under their use, the dysenteric 
affections are removed. In protracted cases of 
autumnal fever, and also subsequent to prostra- 
tion, patients sometimes suffer much from loss 
of sleep. Here, small doses of opium (say 
from one-fourth to one-third of a grain, given at 
intervals of four to six hours, as occasion re- 
quires,) have frequently a very happy effect in 
producing repose ; and, where larger doses 
wholly fail. This practice I derived from Sy- 
denham. 

Where there is sufficient warmth of skin to 
admit of it, instead of giving opium, it is directed 
to sponge the body, or extremities, or both, with 
a napkin wetted in warm water ; and gently to 
wipe off the moisture, as applied with a dry 
napkin. This practice, I have found highly 
conducive to repose in our fevers, and in mam 
other diseases, where there was an unpleasant 
heat in the surface. 

In 1820, I frequently derived decided advan- 
tage from the affusion of cold water, in treating 
fever. Where it is of service, it acts revulsively. 
The same season, 1 used advantageously ene- 
mata of iced water. I never knew injury 
result from them. I have, occasionally, in pro- 
tracted cases of fever, in feeble phlegmatic 
habits, and in delicate women, used a strong \n- 



OF SAVANNAH. 



141 



fusion of ginger, with decided advantage, where 
other medicines did not appear to produce suffi- 
cient warmth. Occasionally , after the fever has 
been subdued, and there is no further occasion 
for the remedies, the tongue still remains furred; 
or if previously clean, becomes so, and the sen- 
sations of the patient, and his alvine evacuations 
indicate a disordered condition of the stomach. 
Here, a few doses of blue pill and castor oil 
usually relieve the alimentary canal from its 
embarrassment ; after which, some cordial tonic 
becomes proper, I have found none' to equal 
the following — 

R. Carbonat. Amonise. grs. xxiv. 

Red Valenan. off. gr. xxxvj. 

Rad Zinziber, jj. 

M. divid. in pulv. No. 12:— 
of which, one may be given every six hours. 
If the bowels should be disposed to costiveness, 
three to five grains of rhubarb may be added to 
each powder. The above combination, I have 
found of infinite service, in cases of dyspepsia ; 
and I recommend it with a confidence derived 
from several years' experience, as imparting a 
tone to the digestive system, in affections of 
that character ; ordinarily most difficult to be 
produced, and yet of the highest importance 
to the patient. 

In the investigation of the symptoms of our 
fevers, great stress has been placed upon the 
appearance of the tongue, or rather the neces- 



142 



AUTUMNAL FEVERS 



sity of that being clean previous to the adminis- 
tration of tonics, and it is required, that that be 
effected by continued evacuations. This is, cer- 
tainly, a very dangerous error. One or two 
active purges given to a person in health, during 
our summer or autumn, will unquestionably pro- 
duce a foulness of this organ : so, in our fevers, 
the furred tongue will be perpetuated by purging 
medicines ; when, by a few doses of bark, ser- 
pentaria, and pepper, given subsequently to the 
application of sinapisms, the appearance of the 
tongue approaches much more nearly to a healthy 
state ; and upon the termination of the disease? 
is for the most part free from fur. Active purg- 
ings in our fevers, by increasing the tendency of 
the blood to the abdominal viscera, vitiate their 
secretions, as manifested by the tongue. At 
every period of a healthy existence, the blood 
vessels are at some one point, discharging ex- 
cretory matter. The great outlets are the skin, 
alimentary canal, and kidneys. Suppress the 
exercise of one of these functions, and that of 
another is increased. This is the whole mystery 
of the occasional, almost immediate, deposite in 
the bladder of fluids, received into the stomach, 
and which has induced many physiologists to 
infer the existence of a direct communication 
between the two. Whilst the motion of the 
blood is estimated upon hydraulic principles, 
such sudden translations will remain unexplained; 
but allow to the system, the existence of a 



QF SAVANNAH. 



143 



power (daily exercised) of varying the determi- 
nation of blood, rapidly and readily, from one part 
to another, and the difficulty is solved. 

The suppression of function, at the same time, 
in the skin, alimentary canal, and kidneys, as 
occasionally occurs in the onset of autumnal 
fever, subjects the patient to a most appalling 
restlessness. Coma supervenes, and death 
speedily closes the scene. Such cases terminate 
usually in less than forty-eight hours ; sometimes 
in little more than half that time. 

In the whole course of my observation, I re- 
collect to have met with but three cases of fever, 
in which, after the inflammation of the skin by 
sinapisms, the pepper, serpentaria, and bark have 
been rejected at every period of the disease. 
Each ot these was successfully treated with 
charcoal,* given in large and frequent doses. One 

* Since my last communication in Chapman's Journal, upon the efficacy 
of charcoal in obstinate constipations, further observation has fully con- 
firmed what was then said in its favour. In several other diseases, I 
have also found this medicine of great utility, and especially in the febrile 
diseases of children ; in which, there are usually extensive secretions of 
slime in the bowels. 

Upon the suggestion of Dr. Screven, I have used it beneficially, for 
worms. In Cholera Infantum, it fulfils indications, which no other medi- 
cine that I have used, would. I have found charcoal highly beneficial in the 
diarrhoea of persons in the decline of life ; where the evacuations give ou* 
a smell similar to that of putrid flesh, though more disagreeable. This 
medicine is certainly destined to become one of the most valuable articles 
of the materia medica, in the treatment of many diseases of the ali- 
mentary canal ; to which, it certainly possesses the power of imparting 
much tone, as well as essentially improving its secretions. It is a valua- 
ble medicine for preparing the digestive organs of dyspeptic patients, for 
*he advantageous exhibition of tonic*. 



144 



AUTUMNAL PEVEUS 



was that of a lad} 7 in the seventh month of preg- 
nancy. The second was that of a girl about 
fourteen years of age, from whom many large 
worms were discharged, in the course of the 
fever. The third was that of a man, treated the 
preceding season with sinapisms, pepper, ser- 
pentaria and I ar 1 when labouring under an 
attack of fever, attended by convulsions. 

In all cases of fever, where the bowels are 
not daily moved, occasional small doses of castor 
oil or an enema, should be administered. It 
should be borne in mind, that in our fevers, 
much smaller doses of medicine purge, than in 
the inflammatory diseases of winter, and in the 
same diseases of more northern latitudes. 

When called late in the disease, where the 
evacuating treatment has been pursued, as fre- 
quently occurs hi the country, the surface of the 
patient is not unusually, (if prostration has not 
already supervened,) found hard, dry, and ine- 
lastic ; and the physician is informed, that 
throughout there has been a complete absence 
of perspiration, or even moisture. Under such 
circumstances, great caution is necessary in sub- 
stituting a tonic course of treatment, and in no 
instance can it be safely done, until the skin, in 
some measure, can be brought to resume its 
functions ; and then, there will be a tendency to 
visceral obstructions from it. The liver will be 
found more or less enlarged, and that motion in 
the integuments over the carotids, so constant in 



OF SAVANNAH. 



chronic disorders of abdominal viscera, will be 
observed. In such cases, the repeated use of 
active purgatives has increased the tendency of 
the blood internally, and by evacuating through 
the bowels a portion of the aqueous part of it, 
has lessened the necessity (so to speak) of the 
internal capillaries, to make a vigorous effort 
to relieve themselves ; and has subjected them 
to a more constant, though measured and re- 
gularly increasing, engorgement. Within the last 
forty years, the extensive introduction of active 
purgatives into the treatment of acute diseases 
has almost revolutionized the science of medi- 
cine ; and no one can doubt, that, in most in- 
stances, it has been done with decided advan- 
tage. That the practice has been carried occa- 
sionally to far, is, too my mind, equally conclu- 
sive ; and no where, perhaps, have they been 
used more disadvantageous^, than in the treat- 
ment of autumnal fever. In this opinion, I 
am supported by names of high authority.* 

* Alexander of Trallis was aware of the great debility which followed 
the use of purgatives, and restricted their use in acute fevers. He suc- 
ceeded better with gentle laxatives, even when there were considerable 
congestions. Sprengel, torn. ii. p. 212. Mesue entertained an aversion 
to purgatives in fevers, in common with other Arabian physicians. IbuL 
272. Arnaud de Villeneuve adopted it as a rule that purgatives increased 
the intensity of Quartans. Ibid. 443. Leonhar Fuches considered put 
gativesas producing the most injurious effect in intermittents. Ibid. torn. 
iii. p. 12. Vantlelmont was the greatest hemataphobe that ever lived, and 
was opposed to evacuants generally. When any were required, he used 
the mildest. Ibid. torn. v. p. 401. Cullcn and others opposed the use of 
purgatives in autumnal fevers. 

T 



146 



AUTUMN" AIj FEVERS 



The opinion has been already expressed, that 
the use of drastic purgatives may change the 
type of fever, from an intermittent to a remit- 
tent. Where they do, it is by diverting a por- 
tion of the blood, thrown in upon the internal 
capillaries by the regular operation of the fever, 
from them to those of the alimentary canal; 
whereby the volume of blood in the former is 
lessened by the discharge of some of the aqueous 
portion into the intestines ; and the internal ca- 
pillaries, are, in some measure, relieved from the 
necessity (so to speak) of an immediate reaction, 
which would have terminated in a perspiration, 
resolving the paroxysm. It is not (nor can it be) 
denied, that the administration of a purge is oc- 
casionally serviceable in the treatment of au- 
tumnal fever; but then, that service is an inci- 
dental, and not an intrinsic consequence; and 
dependent upon the precise condition of the 
vascular system at the moment, and not upon the 
habitual action*of the medicine. Rush has, with 
great justice, somewhere remarked, that, what 
will at one time produce perspiration, will at 
another time, prevent it; according, as he says, 
" to the state of the system ;" and instances, if I 
am not mistaken, the effect of cold water taken 
into the stomach, producing at one time per- 
spirations, and at another, suppressing them. 
The same obtains in the use of purgatives. 
Whenever they are serviceable in autumnal fe- 
ver, their operation is attended by pespiration, 



OF SAVANNAH. 



147 



and they act revulsively. Here, they relieve the 
internal capillaries from an oppressive volume 
of blood; whereby Jthey are enabled to react, 
and produce a perspiration resolving the parox- 
ysm. This is equally correct in the use of blood- 
letting in the same disease. Under some cir- 
cumstances, I have used the lancet with decided 
advantage ; and then always, the depletion was 
critical ; perspirations following through a re 
vulsive agency. But certainly, in neither, would 
such success establish a general rule for the use 
of either. 

Cathartics given in the forming stage of fever, 
usually fully develope it. They certainly, as 
well as bleedings, very obviously increase the 
tenderness upon pressure, over the stomach, as 
well as increase its irritability. They frequently 
repel eruptions from the surface, upon the re- 
storation of which, improvement follows, i, of 
course, speak of purgatives, in contra distinction 
to mere evacuants ; for all acknowledge that 
costiveness should be obviated in treating fevers. 
Although some diversity of opinion exists else- 
where, as to the propriety of emetics, in the 
treatment of autumnal fevers, the physicians of 
this place are, I believe, unanimous in rejecting 
them. Yet, they have occasionally even here, 
been advantageously given. I have supposed, 
that when they are beneficial, (for I have not 
known such instance, where there was much 
severity of disease) it js through a revulsive ar 



148 



AUTUMNAL FEVERS 



lion. I was in 1817, strongly impressed with the 
danger which frequently follows the use of tar- 
tar emetic in autumnal fevers. The high price 
of, and great demand for, Indian corn that sum- 
mer, in this place, tempted an unusual number 
of northern schooners, freighted with that arti- 
de, into this port, late in summer. Fever soon 
seized their crews. (All know the great economy 
habitually observed in these vessels.) They were 
usually provided with sulphate of soda and tar- 
tar emetic, which were, in combination, habitually 
given to the sick. The situation of health offi- 
cer, which I then held, occasioned my employ- 
ment for many of these sick seamen. I was fre- 
quently called to see such as had upon the su- 
pervention of tever, taken this combination, 
twelve and twenty hours after its administration. 
I usually found them in a state of great exhaus- 
tion, with constant retchings, great tenderness of 
the stomach upon pressure, great pain and heat 
in the head, and covered with cold clammy, 
or profuse cold perspirations, and with very little 
or no pulsation at the wrists. Few survived this 
condition, many hours. The use of emetics 
(and especially of tartar) rapidly increases the 
debility ot fever ; and not only impairs the re- 
action of the internal capillaries, but increases 
the tendency of the blood internally. Tartar 
emetic, or sulphate of zinc and sulphate of soda, 
in combination, are habitually prescribed upon 
plantations on the sea-coast of South Carolina 



OF SAVANNAH. 



149 



and Georgia, in ordinary cases of autumnal fe- 
vers and pleurisies, to the negroes ; and gene- 
rally with decided advantage. Usually, the com- 
bination pukes and purges ; upon which, perspi- 
rations (especially in the fevers) follow. Here the 
action is evidently revulsive. It should be borne in 
mind, that cases of autumnal fevers, in this class 
of our population, are obviously very mild ; and 
that the simplicity of their diet, as well as other 
circumstances, heretofore alluded to, not only 
render them less obnoxious to the causes of fe- 
ver, but also much more readily curable than 
the whites. 

Such is the method of treating our autumnal 
fevers, which I have pursued for several years, 
and certainly with a decided success. Under 
every modification of symptom, the spirit of that 
treatment should be rigidly adhered to ; and it 
is only to such as are disposed to try it in sin- 
cerity and t^uth, that I recommend it. It is ne- 
cessary to the successful administration of the 
bark, pepper, and serpentaria, in the proper 
quantities, that the skin should be first fully in- 
flamed in some parts ; otherwise these medicines 
will be rejected, or produce such embarrassment 
as to forbid their continued use. I am anxious to 
impress this fully upon my readers, for upon it 

DEPENDS THE SUCCESS OF THE WHOLE SYSTEM 

of treatment. A mere rubefacient effect from 
the sinapisms, though temporarily serviceable, 
will not answer in severe cases. The skin 



150 AUTUMNAL FEVERS • 

MUST BE INFLAMED ; AND THAT INFLAMMATION 
KEPT UP THROUGHOUT THE WHOLE COURSE OF 

the disease. From fevers, thus treated, pa- 
tients recover almost as speedily as their attacks 
were sudden ; and retain very few, if any ves- 
tiges of the disease. Where there has previous- 
ly existed considerable visceral obstruction in 
the abdomen, more caution is necessary in the 
administration of the tonics ; and sometimes, 
in such, there is some tendency to inflammatory 
action, arising from the condition of some of the 
disordered viscera. Hence, the justness of the 
remark of Dr e Screven, to me, that under this 
system of treatment, the Irish almost constantly 
recover ; when with the former mode of treat- 
ment, their fevers were generally fatal, as ample 
experience here has shown. The same remark 
applies with equal truth to New-Englandmen. 

The treatment here recommended would cer- 
tainly increase inflammatory fevers. This is ex- 
emplified by the use of the heating regimen in 
small-pox. It would be positively injurious in 
inflammations, as pleurisy, &c. It has been con- 
tended that bark merely suspends fevers. If it $ 
did no more, it would: certainly still be valuable. 

If the tenderness of the stomach was owing to 
inflammation, sinapisms would not suddenly ar- 
rest it: it would eventually prove frequently fatal, 
or terminate as do other inflammations. More- 
over, the sensations of the patient connected with 
the stomach, are different in autumnal fevers. 



OF SAVANNAH. 



151 



from those experienced in gastrites. In the for- 
mer, they are vague and unclefinable. The re- 
verse obtains in the latter. In autumnal fevers, 
there is a shortening, and consequently, thick- 
ening, of the tongue ; when protruded through 
the lips, it has frequently a tumulous motion, 
which the patients cannot suppress. It is fre- 
quently hard and dry, with a brown coat during 
the exacerbation of fever ; sometimes traversed 
by numerous sulci, or deep cracks, which re- 
main long after the termination of the disease. 
How different from these, are the appearances 
presented in inflammatory diseases ? 

In inflammatory diseases, the bowels are 
bound ; and the evacuations produced by pur- 
gatives, are slimy and thick ; in autumnal fevers, 
after the ingesta are discharged, the evacuations 
are thin and watery, and there is a. tendency to 
looseness. 

In inflammatory diseases, the appearance of 
perspiration is habitually salutary : and an es- 
sential object in the treatment, is their produc- 
tion. In autumnal fevers, and especially in se- 
vere cases, they frequently are present through- 
out the disease, and to the obvious detriment of 
the patient ; and their suppression is highly im- 
portant to recovery. 

It will at once be perceived, that the foregoing 
system of treatment depends for its success, main- 
ly, upon its revulsive powers over the system. 
It is this, I am chiefly desirous of impressing 



152 



AUTUMNAL FEVERS, &C. 



upon my readers; for I have no doubt but that 
any other plan of treatment, equally revulsive in 
its character, and equally suited to maintain an 
equalized action of the system, when once pro- 
duced, would be full as efficient. 

I have arrived at my conclusions, slowly and 
cautiously. — They are offered to the medical 
public, under a conviction (perhaps erroneous) 
of their importance, forced upon me by the ob- 
servation of several years. 

In concluding these brief remarks, I may be 
permitted to observe, that they have been pen- 
ned at moments snatched from other, and more 
pressing and active pursuits. They are submit- 
ted in their present imperfect and defective 
shape, only because I have not further leisure 
to devote to them. I hope I have made myself 
intelligible. I have aspired to nothing more. 
What I have here reported, must finally rest 
upon the accuracy of my observations, and the 
correctness of my inferences from them. Of the 
former, I speak with a confidence not to be 
shaken ; of the latter, others may judge. 



THE END. 



•'• & .T. Harper. Printers, New-York. 



It D 2 14. 



